Methods and compositions for mitigating pain

ABSTRACT

Methods and therapeutic compounds for treating pain, mitigating inflammation, effecting analgesia and/or effecting sedation in a subject are described. A subject is administered an effective amount of a therapeutic compound which is a nitrate ester. Novel pharmaceutical compositions are also described.

CROSS-REFERENCE TO RELATED APPLICATIONS

The application is a continuation of U.S. Ser. No. 09/473,713, filedDec. 29, 1999, which is incorporated herein by reference.

FIELD OF THE INVENTION

This invention relates to nitrate esters and use thereof in mitigatingpain and effecting analgesia. More particularly this invention relatesto organic nitrates which have therapeutic utility as analgesics,anti-inflammatory agents and sedatives.

BACKGROUND OF THE INVENTION

The nitrate ester, glyceryl trinitrate (GTN), or nitroglycerin, has beenused as a vasodilator in the treatment of angina pectoris for over ahundred years, and the dominant, contemporary belief is that GTN exertsits therapeutic effect through in tivo release of nitric oxide (NO).Other organic nitrates (nitrate esters), such as isosorbide dinitrate,have also been identified as effective and clinically importantvasodilators. NO itself has been identified as Endothelium DerivedRelaxing Factor (EDRF) and several classes of compounds, for examplenitrosothiols, in addition to organic nitrates, have been proposed as NOdonors or NO prodrugs.

Several organic nitrates, in which an alkyl mononitrate is appended to amoiety with analgesic properties, such as aspirin (ASA) or aNon-Steroidal Anti-Inflammatory Drug (NSAID) have been reported asanalgesics which possess reduced gastro-intestinal irritation andulceration properties, purportedly through release of NO. Thecombination of the vasodilator nitroglycerin with opioid analgesics suchas morphine, has been suggested to be effective in the management ofboth surgical and cancer pain. However, no attempt has been made todevelop organic nitrates themselves as analgesic agents, that is,organic nitrates that do not rely on an ASA or NSAID moiety, nor anopiate, for analgesic properties. Thus, there is a need for syntheticorganic nitrates as new and useful therapeutic agents for treatment andmitigation of pain associated with disease states and chemotherapy ofthose disease states.

OBJECT OF THE INVENTION

It is an object of the present invention to provide methods andcompositions for use in treating pain and/or conditions associated withpain. Another object of the present invention is to provide methods andcompositions for providing analgesia and/or sedation.

BRIEF DESCRIPTION OF THE INVENTION

The present invention is based, at least in part, on the recognitionthat, although the potent vasodilatatory effects of organic nitrates maybe either (a) deleterious to or, alternatively, (b) synergis tic withtheir analgesic effects, regulation of these two effects is required forthe development of therapeutic agents useful in treatment and mitigationof pain. Pain may be treated or mitigated by, for example, an analgesic,anti-inflammatory and/or sedative agent.

Possible deleterious effects of organic nitrates may arise, for example,through an NO-donor potentiating hyperalgesia via a cyclicguanosine-3,5-monophosphate (cGMP)-independent mechanism. Alternatively,synergistic effects of organic nitrates may arise, for example, throughthe ability of an NO-donor to induce analgesia by activation of solubleguanylyl cyclase (GCase) and elevation of cGMP levels. The presentinvention relates to methods for treating or mitigating pain through useof an organic nitrate, wherein regulation of these two effects isachieved. According to the invention, selection of an appropriateorganic nitrate provides modulation and balance between the ability ofthe organic nitrate to release NO and its potency for GCase activation.Inasmuch as gastrointestinal toxicity is known to be a deleterious sideeffect of some analgesic drugs and that NO donor molecules aregastro-protective, it is set forth herein that therapeutic analgesia canbe achieved through utilization of an appropriate organic nitrate. Thisstatement is based, at least in part, on bioassay data on suchcompounds.

This invention provides methods and compositions which are useful intreating pain, inhibiting inflammation, and/or providing analgesia.Methods of the invention involve administering to a subject atherapeutic compound (nitrate ester) which provides analgesia. Themethods and compositions of the invention are useful for the treatmentand mitigation of pain associated with disorders and disease states andchemotherapy of those disease states. The methods and compositions ofthe invention can be used therapeutically to treat acute, chronic and/orinflammatory pain in conditions such as, but not limited to, nerveinjury, post-herpetic neuralgia, arthritis, diabetic neuropathy,dysmenorrhea, endometriosis, phantom limb pain, pain associated withcancer and post-operative pain, or can be used prophylactically in asubject susceptible or predisposed to these conditions. In certainpreferred embodiments, a therapeutic compound used in the method of theinvention interacts with guanylyl cyclase, effecting analgesia. In otherpreferred embodiments, a therapeutic compound used in the method of theinvention modulates levels of the cyclic nucleotides cyclicguanosine-3′,5′- monophosphate (cGMP) and cyclicadenosine-3′,5′-monophosphate (cAMP).

In one aspect, the invention provides a method for treating pain,treating or inhibiting inflammation, providing analgesia, providingsedation, mitigating anxiety and/or providing anaesthesia in a subject,comprising administering to a subject in need thereof an effectiveamount of a therapeutic compound, wherein the therapeutic compound is ofthe formula (Ia):

in which E, F¹, F², G¹, and G² are the same or different organicradicals which may be joined in cyclic ring systems, and which maycontain inorganic counterions;

with the proviso that when E and G¹ are methylene groups and F¹ is H, G²is not a nitrate group, nor R^(N)-Z^(N)-;

wherein R^(N) is any aryl or heteroaryl group and Z^(N) is(CO)_(mm)-X^(N) _(nn)-Y^(N) _(oo);

wherein mm, nn, oo are 0 or 1 and X^(N),Y^(N) are NH, NR^(NN), O or CH₂;

wherein R^(NN) is a short chain alkyl group (C₁-C₁₂).

In a preferred embodiment, F² is a nitrate group and E, F¹, G¹, G² arethe same or different organic radicals which may be joined in cyclicring systems, and which may contain inorganic counterions;

with the proviso that when E and G¹ are methylene groups and F1 is H, G²is not a nitrate group, nor R^(N)-Z^(N)-;

wherein R^(N) is any aryl or heteroaryl group and Z^(N) is(CO)_(mm)-X^(N) _(nn)-Y^(N) _(oo);

wherein mm, nn, oo are 0 or 1 and X^(N),Y^(N) are NH, NR^(NN), O or CH₂;

wherein R^(NN) is a short chain alkyl group (C₁- C₁₂)

In another aspect, the invention provides a method for treating pain,treating or inhibiting inflammation, providing analgesia, providingsedation, mitigating anxiety and/or providing anaesthesia in a subject,comprising administering to a subject in need thereof an effectiveamount of a therapeutic compound, wherein the therapeutic compound is ofthe formula (Ib):

in which F² is an organic radical which may be joined in a cyclic ringsystem with G², and which may contain inorganic counterions; E and G¹are both methylene groups; F¹ is H; and G² is R^(N)-Z^(N)-;

wherein R^(N) is an organic radical possessing a heteroaryl groupcontaining P or S atoms where said P or S are positioned β, γ, or δ to anitrate group as identified in formula I; and ZN is W^(N) _(mm)-X^(N)_(nn)-Y_(N) _(oo);

wherein mm, nn and oo are 0 or 1; and W^(N), X^(N), Y^(N) are NH,NR^(NN), CO, O or CH₂;

wherein R^(NN) is a short chain alkyl group (C₁-C₁₂).

In a preferred embodiment, F² is a nitrate group; E and G¹ are methylenegroups; F¹ is H; and G² is R^(N)-Z^(N)-;

wherein R^(N) is an organic radical possessing an heteroaryl groupcontaining P or S atoms where said P or S are positioned β, γ, or δ to anitrate group as identified in formula I; and Z^(N) is W^(N) _(mm)-X^(N)_(nn)-Y^(N) _(oo);

wherein mm, nn, oo are 0 or 1 and W^(N), X^(N), Y^(N) are NH, NR^(NN),CO, O or CH₂;

wherein R^(NN) is a short chain alkyl group (C₁-C₁₂).

In another aspect, the invention provides a method for treating pain,treating or inhibiting inflammation, providing analgesia, providingsedation, mitigating anxiety and/or providing anaesthesia in a subject,comprising administering to a subject in need thereof an effectiveamount of a therapeutic compound, wherein the therapeutic compound is ofthe formula (1c):

in which E is (R¹R²C)_(m) and G²-G¹-CF¹F²- isR¹⁹-(R³R⁴C)_(p)-(R¹⁷R¹⁸C)_(n)-;

-   -   wherein: m, n, p are integers from 0 to 10;    -   R^(3,17) are each independently hydrogen, a nitrate group, or A;        and    -   R^(1,4) are each independently hydrogen, or A;

where A is selected from a substituted or unsubstituted aliphatic group(preferably a branched or straight-chain aliphatic moiety having from 1to 24 carbon atoms in the chain, which optionally may contain O, S, NR⁶and unsaturations in the chain, optionally bearing from 1 to 4 hydroxy,nitrate, amino, aryl, or heterocyclic groups; an unsubstituted orsubstituted cyclic aliphatic moiety having from 3 to 7 carbon atoms inthe aliphatic ring, which optionally may contain O, S, NR⁶ andunsaturations in the ring, optionally bearing from 1 to 4 hydroxy,nitrate, amino, aryl, or heterocyclic groups; an unsubstituted orsubstituted aliphatic moiety constituting a linkage of from 0 to 5carbons, between R¹ and R³ and/or between R¹⁷ and R⁴, which optionallymay contain O, S, NR⁶ and unsaturations in the linkage, and optionallybearing from 1 to 4 hydroxy, nitrate, amino, aryl, or heterocyclicgroups); a substituted or unsubstituted aliphatic group (preferably abranched, cyclic or straight-chain aliphatic moiety having from 1 to 24carbon atoms in the chain) containing carbonyl linkages (e.g., C═O, C═S,C═NOH), which optionally may contain O, S, NR⁶ and unsaturations in thechain, optionally bearing from 1 to 4 hydroxy, nitrate, amino, aryl, orheterocyclic groups; a substituted or unsubstituted aryl group; aheterocyclic group; amino (including alkylamino, dialkylamino (includingcyclic amino, diamino and triamino moieties), arylamino, diarylamino,and alkylarylamino); hydroxy; alkoxy; a substituted or unsubstitutedaryloxy;

wherein X is F, Br, Cl, NO₂, CH₂, CF₂, O, NH, NMe, CN, NHOH, N₂H₃,N₂H₂R¹³, N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(R¹⁵)₂, SCN₂H₃(R¹⁵), SC(O)N(R¹⁵)₂,SC(O)NHR¹⁵, SO₃M, SH, SR⁷, SO₂M, S(O)R⁸, S(O)-R9, S(O)OR⁸, S(O)₂O R⁹,PO₂HM, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR8),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O), C(O)RI², C(O)(OR¹³), PO₂H,PO₂M,P(O)(OR¹⁴), P(O)(R¹³), SO, SO₂, C(O)(SR1³), SR⁵, SSR⁷ or SSR⁵; Y isF, Br, Cl, CH₃, CF₂H, CF₃, OH, NH₂, NHR⁶, NR⁶R⁷, CN, NHOH, N,H₃,N₂H₂RI³, N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(RI5)₂, SCN₂H₃(R¹⁵), SC(O)N(R¹⁵)₂,SC(O)NHR¹⁵, SO₃M, SH, SR⁷, SOSM, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)₂O R⁹,PO₂HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R15)(OR8),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O)R¹², C(O)(OR¹³), C(O)(SR¹³), SR⁵,SSR⁷ or SSR⁵, or does not exist;

R², R⁵, R¹⁸, R¹⁹ are optionally hydrogen, A or X-Y;

R⁶, R⁷, R⁸, R⁹, R¹¹, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶ are the same or differentalkyl or acyl groups containing 1-24 carbon atoms which may contain 1-4ON0₂ substituents; or Cl - C₆ connections to R¹- R⁴ in cyclicderivatives; or are each independently hydrogen a nitrate group or A;

M is H, Na+, K+, NH₄+, N+H_(k)R¹¹(4-k) where k is 0-3; or otherpharmaceutically acceptable counterion;

and with the proviso that when m=n p=1 and R¹⁹, R², R¹⁸, R¹=H and R¹⁷,R³ are nitrate groups, R⁴ is not H.

In a preferred embodiment, R¹⁹ is X-Y.

In other embodiments, R¹ and R³ are the same or different and selectedfrom H and Cl-C₄, alkyl chains, which chains may include one 0 linkingR¹ and R³ to form pentosyl, hexosyl, cyclopentyl, or cyclohexyl rings,which rings may optionally bear hydroxyl substituents;

R² and R⁴ are the same or different and selected from H, a nitrategroup, Cl-C₄ alkyl chains optionally bearing 1-3 nitrate groups, andacyl groups (-C(O)R⁵);

R⁷, R¹¹ are the same or different Cl - C₈ alkyl or acyl;

R⁵, R⁶, R⁸, R⁹, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶ are the same or different andare alkyl groups containing 1-12 carbon atoms which may contain 1-4 ONO₂substituents; or C₁ or C₂ connections to R¹- R³in cyclic derivatives;and

M is H, Na⁺, K⁺, NH₄ ⁺ or N⁺H_(k)R¹¹(4-k),where k is 0-3.

In other embodiments, m=1, n=0, p=1.

In further embodiments, X is CH₂, O, NH, NMe, CN, NHOH, N₂H₃, N₂H₂R¹³,N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(RI⁵)₂, SCN₂H₃(R⁵), SC(O)N(R¹⁵)₂,SC(O)NHR¹⁵, SO₃M, SH, SR⁷, SO₂M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)₂OR⁹,PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R15)(OR⁸),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O), C(O)R¹², C(O)(OR¹³), PO₂M,P(O)(OR¹⁴), P(O)(R¹³), SO, SO₂, C(O)(SR¹³), or SSR⁴; and

Y is CN, N₂H₂R¹³, N₂HR¹³R¹⁴, N₃, SCN, SCN₂H₂(R¹⁵)₂, SC(O)N(R¹⁵)₂,SC(O)NHR¹⁵, SO₃M, SR⁴, SO₂M, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶),P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR⁸), P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹,C(O)R¹², C(O)(SR¹³), SR⁵, or SSR⁵, or does not exist.

In yet further embodiments, R⁵, R⁶, R⁸, R⁹, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶ arethe same or different and are alki4s containing 1-12 carbon atoms; or Clor C2 connections to R¹ or R³ in cyclic derivatives;

X is CH₂, O, NH, NMe, S, SO₃M, SH, SR⁷, SO₂M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸,S(O)₂O R⁹, PO₃M₂, P(O)(OR1⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR8),PO₃HM or P(O)(OM)R¹⁵; and

Y is SOM, SO₃M, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), SR⁵, SR⁴or SSR⁵, or does not exist.

In preferred embodiments, therapeutic compounds of the invention act asanalgesic, sedative and/or anti-inflammatory agents. Preferredtherapeutic compounds for use in the invention include compounds havingthe formula (Formula II):

(Formula II)

in which: m and n and p are integers from 0 to 10;

R^(3,17) are each independently hydrogen; a nitrate group; or A;

R^(1,4) are each independently hydrogen; or A;

where A is selected from: a substituted or unsubstituted aliphatic group(preferably a branched, or straight-chain aliphatic moiety having from 1to 24 carbon atoms in the chain, which optionally may contain 0, S, NR⁶and unsaturations in the chain, optionally bearing from 1 to 4 hydroxy,or nitrate, or amino or aryl, or heterocyclic groups; an unsubstitutedor substituted cyclic aliphatic moiety having from 3 to 7 carbon atomsin the aliphatic ring, which optionally may contain O, S, NR⁶ andunsaturations in the ring, optionally bearing from 1 to 4 hydroxy, ornitrate, or amino 8 or aryl, or heterocyclic groups; an unsubstituted orsubstituted aliphatic moiety constituting a linkage of from 0 to 5carbons, between RI and R³ and/or between R¹⁷ and R⁴, which optionallymay contain 0, S, NR⁶ and unsaturations in the linkage, and optionallybeating from 1 to 4 hydroxy, or nitrate, or amino or aryl, orheterocyclic groups); a substituted or unsubstituted aliphatic group(preferably a branched, cyclic or straight-chain aliphatic moiety havingfrom 1 to 24 carbon atoms in the chain), containing carbonyl linkages(e.g., C=O, C=S, C=NOH), which optionally may contain 0, S, NR⁶ andunsaturations in the chain, optionally bearing from 1 to 4 hydroxy, ornitrate, or amino or aryl, or heterocyclic groups; a substituted orunsubstituted aryl group; a heterocyclic group; ammno (includingalkylamino, dialkylamino, such as cyclic amino, diamino and triaminomoieties), arylamnino, diarylanino, and alkylarylamino); hydroxy;alkoxy; a substituted or unsubstituted aryloxy.

R², R⁵, R¹⁸, R¹⁹ are optionally hydrogen; or A; or X-Y. where X is F,Br, Cl, NO₂, CH₂, CF₂, O, NH, NMe, CN, NHOH, N₂H₃, N₂H₂R¹³, N₂HR¹³R¹⁴,N₃, S, SCN, SCN₂H₂(R¹⁵)₂, SCN2H3(RI⁵), SC(O)N(R¹⁵)₂, SC(O)NHR¹⁵, SO₃M,SH, SR⁷, SO₂M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)₂O R⁹, PO₂HM, PO₃HM, PO₃M₂,P(O)(OR¹⁵)(OR1⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR⁸), P(O)(OM)RI⁵, CO₂M,CO₂H, CO₂R¹¹, C(O), C(O)R¹², C(O)(OR¹³), PO₂H, PO2M,P(O)(OR¹⁴),P(O)(R13), SO, SO₂, C(O)(SR¹³), SR⁵, SSR⁷ or SSR⁵, Y is F, Br, Cl, CH₃,CF₂H, CF₃, OH, NH₂, NHR⁶, NR⁶R⁷, CN, NHOH, N₂H₃, N₂H2R¹³, N₂HR¹³R¹⁴, N₃,S, SCN, SCN₂H₂(RI⁵)₂, SCN₂H₃(R¹⁵), SC(O)N(R⁵)₂, SC(O)NHR¹⁵, SO₃M, SH,SR⁷, SO-M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)₂O R⁹, PO₂HM, PO₃M₂,P(O)(OR1⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR8), P(O)(OM)R¹⁵, CO₂M,CO₂H, CO₂R¹¹, C(O)R¹², C(O)(OR¹³), C(O)(SR¹³), SR⁵, SSR⁷ or SSR⁵, ordoes not exist;

R⁶, R⁷, R⁸, R⁹, R¹⁰, R¹l, R1², R¹³, R¹⁴, R¹⁵, R¹⁶ are the same ordifferent alkyl or acyl groups containing 1-24 carbon atoms which maycontain 1-4 ON0₂ substituents; or C₁ - C₆ connections to R¹ - R⁴ incyclic derivatives; or are each independently hydrogen; a nitrate group;or W.

M is H, Na⁺, K⁺, NH₄ ⁺, N⁺H_(k)R¹¹(4-k) where k is 0-3, or otherpharmaceutically acceptable counterion; and with the proviso that, whenm=n=p=1; R¹⁹, R², R¹⁸, R¹=H; R¹⁷, R³ are nitrate groups; that R⁴ is notH or C -C3 alkyl.

In certain preferred embodiments, therapeutic compounds of the inventionare analgesic, sedative and/or anti-inflammatory agents. Preferredtherapeutic compounds for use in the invention include compounds inwhich R¹⁹ is X-Y. In a particularly preferred embodiment: R¹⁹ is X-Y andR⁵, R⁶, R⁸, R⁹, R¹⁰, R¹², R¹³, R¹⁴, R¹⁵, R¹⁶ are the same or differentalkyl groups containing 1-24 carbon atoms which may contain 1-4 ON0₂substituents, or Cl or C2 connections to R¹-R³ in cyclic derivatives; R¹and R³ are the same or different and selected from H, Cl-C₄, alkylchains, which may inlude one O, linking R¹ and R³ to form pentosyl,hexosyl, cyclopentyl, or cycohexyl rings, which rings may optionallybear hydroxyl substituents; R² and R⁴, are the same or different andselected from H, a nitrate group, Cl-C₄ alkyl optionally bearing 1-3nitrate groups, and acyl groups (—C(O)R⁵); R⁷, R¹¹ are the same ordifferent C₁-C₈, alkyl or acyl..

In certain embodiments in which Rig is X-Y, m, p=1, and n=0. In otherembodiments in which Rig is X-Y, X is selected from CH₂, O, NH, NMe, CN,NHOH, N₂H₃, N₂H₂R¹³, N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(R¹⁵)₂, SCN₂H₃(R¹⁵),SC(O)N(R¹⁵)₂, SC(O)NHR¹⁵, SO₃M, SH, SR⁷, SO,M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸,S(O)₂OR⁹, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM),P(O)(R¹⁵)(OR⁸), P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O), C(O)R¹²,C(O)(OR¹³), PO?M, P(O)(OR¹⁴), P(O)(R¹³), SO, SO₂, C(O)(SR¹³), SSR⁴. Inanother embodiment in which Rig is X-Y, Y is selected from CN, N₂H₂R¹³,N₂HR¹³R¹⁴, N₃, SCN, SCN₂H₂(R¹⁵)₂, SC(O)N(R¹⁵)₂, SC(O)NHR¹⁵, SO₃M, SR⁴,SO₂M, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR⁸),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO?R¹, C(O)R¹², C(O)(SR¹³), SR⁵, SSR⁵, or doesnot exist. In a further embodiment, X and/or Y contain asulfur-containing functional group. In certain preferred embodiments,the compound of the invention comprises a heterocyclic functionality,more preferably, a nucleoside or nucleobase. In further preferredembodiments, the compound of the invention comprises a carbocyclicfunctionality, more preferably, a steroidal or carbohydrate moiety.

In another aspect, a therapeutic compound of the invention isrepresented by the formula (Formula III):

in which: m is 1-10; R¹⁻¹⁸, X, and Y have the meaning as defined above.In certain preferred embodiments, R⁶ - R¹⁶ are the same or differentalkyl or acyl groups contaiunig 1-24 carbon atoms which may contain 1-4ON0₂ substituents, or Cl - C6 connections to R¹-R⁴ in cyclicderivatives. In certain preferred embodiments, R1⁸ is A and n=1.

In preferred embodiments, a therapeutic compound of the invention isrepresented by the formula (Formula IV):

in which: R³, R¹═H; n, R² R4-¹⁸, X, and Y have the meaning as definedabove. In preferred embodiments, X is CH₂ or does not exist, and Y isselected from, F, Br, Cl, CH₃, CF₂H, CF₃, OH, NH₂, NHR6, NR6R₇, CN,NHOH, N2H₃, N₂H₂R₁₃, N₂HR₁₃R₁₄, N₃, S, SCN, SCN₂H₂(R₁₅)₂, SCN₂H₃(R¹⁵),SC(O)N(R¹⁵)₂, SC(O)NHR₁₅, SO₃M, SH, SR₇, SO₂M, S(O)R8, S(O)₂R₉, S(O)OR8,S(O)₂O R₉, PO₂HM, PO₃M₂, P(O)(OR₁₅)(OR₁₆), P(O)(OR₁₆)(OM),P(O)(Ris)(OR8), P(O)(OM)R15, CO₂M, CO₂H, CO₂R₁l, C(O)R₁₂, C(O)(ORi₃),C(O)(SR₁₃), SR₅, SSR₇ or SSR₅. In certain preferred embodiments, R₂ andR₄ are optionally H, a nitrate group or a connection to R₅-R₁₆ in cyclicderivatives.

In certain preferred embodiments, a compound of the invention isrepresented by the formula (Formula V):

in which m, n, R¹⁻¹⁸, X, and Y have the meaning as defined above.

In another aspect, the invention includes novel compounds useful fortreating pain, mitigating inflammation, effecting analgesia and/orproviding sedation. The compounds of the invention can be represented bythe structures shown hereinbelow, for example, the structures of FormulaIII, IV and V. Novel compounds of the invention include nitrates IlIr -IIIaj, Vn - Ivt, and Vd-Vag, whose syntheses are described in thefollowing examples.

The invention also provides methods for treating a disease stateassociated with inflammation, comprising administering to a subject aneffective amount of a therapeutic compound having a formula set forthabove, such that a disease state associated with inflammation istreated.

The invention further provides methods for treating a disease state ordisorder in which a level of sedation is desired, comprisingadministering to a subject an effective amount of a sedative therapeuticcompound having a formula set forth above, such that a disease state ordisorder is treated.

The invention provides methods for effecting analgesia comprisingadministering to a subject an effective amount of a therapeutic compoundhaving a formula set forth above, such that analgesia is effected.

The invention father provides novel pharmaceutical compositions fortreating pain, mitigating inflammation, effecting analgesia and/oreffecting sedation. A said pharmaceutical composition comprises atherapeutic compound of the invention in an effective amount for theparticular indication and a pharmaceutically acceptable vehicle.

The invention also provides packaged pharmaceutical compositions fortreating pain, mitigating inflammation, effecting analgesia and/oreffecting sedation. The packaged pharmaceutical compositions include atherapeutic compound of the invention and instructions for using thepharmaceutical composition for treatment of inflammation and/or pain.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a graph showing the effect of IVd neat (diamonds); with addedL-cysteine (2mM, triangles); with added dithiothreitol (2 mM, DTr,squares); on soluble GCase activity in rat aorta homogenate normalizedto the maximal GTN response. Bars represent the mean±standard errorscalculated separately for each point.

FIG. 2(a-b) is a graph showing the comparison of GTN (squares), IlIm(circles) and IVh (triangles) with added L-cysteine (1 mM) on solubleGCase activity in rat aorta homogenate (a), and rat hippocampushomogenate (b). Data points represent the mean of duplicatedeterminations carried out in identical GCase preparations.

FIG. 3(a-b) is a graph showing the comparison of GTN (squares), Va(circles) and Vb (triangles) with added L-cysteine(1 mM) on solubleGCase activity in rat aorta homogenate homogenate (a), and rathippocampus homogenate (b). Data points represent the mean±standarderrors calculated separately for each point (n=8-1 1).

FIG. 4(a-b) is a graph showing the comparison of cyclic GMP accumulationin isolated rat aorta induced by diluent (basal, open bar), GTN (filledbar), Va (stippled bar), or IIIm (hatched bar). Segments of rat aortawere exposed to diluent, 1 pM drug (a), or 1 0uM drug (b) for 1 min andcyclic GMP content determined by radioinmuunoassay. Data are themean±standard errors (a, n=8; b, n=5).

FIG. 5(a-b) is a graph showing the comparison of cyclic GMP accumulationin isolated rat aorta induced by diluent (basal, open bar), GTN (filledbar), WVk (stippled bar ),Vb (cross-hatched bar), or Vc (hatched bar).Segments of rat aorta were exposed to diluent, 1 tM drug (a), or 10tMdrug (b) for 1 mmn and cyclic GMP content determined byradioinmmunoassay. Data are the mean±standard errors (a, n=5; b, n=4).

FIG. 6(a-b) is a graph showing cyclic GMP accumulation in rathippocampal slices induced by diluent (basal, open bar), GTN (filledbar), and Va (stippled bar). Sections of rat hippocampus (400 μm) wereprepared and exposed to diluent, 10 μM drug (a) or 100 μM drug (b) for 3min and cyclic GMP content determined by radioirnmunoassay. Data are themean±standard errors (a, n=4; b, n=5).

FIG. 7 is a graph showing the comparison of relaxation of isolated rataorta induced by GTN (squares), Va (open triangles), compound I⁷c(diamonds), compound WVd (open squares), compound IVf (triangles), andcompound WVg (open diamonds). Data points represent the mean i standarderrors (n=5-8).

FIG. 8 is a graph showing the comparison of relaxation of isolated rataorta induced by GTN (squares), IVk (open triangles), Vb (diamonds),IIIm (open squares), Vc (triangles), and IVh (open diamonds). Datapoints represent the mean±standard errors (n=3-8).

FIG. 9 is a graph showing the comparison of the percent change in meanarterial pressure (MAP) in conscious unrestrained rats aftersubcutaneous administration of 400 μmol/kg GTN (squares) or Va (opencircles). Data points represent the mean i standard errors (n=6).

FIG. 10 is a graph showing the comparison of the percent change in meanarterial pressure in Inactin anaesthetized rats after intravenous bolusinjection of GTN (squares) or Va (open circles). Data points representthe mean i standard errors (n=4).

FIG. 11 is a graph showing the plasma levels (uM) of Vb (circles) andits mononitrate metabolite Vc (open squares) after subcutaneousadministration of 200 μmol/kg Vb in conscious unrestrained rats. Datapoints represent the mean of two experiments.

FIG. 12(a-b) is a graph showing the relaxation induced by compound WVd(a) and Ivc (b) in untreated (squares) and GTN-tolerant (circles)isolated rat aorta. Aortae were made tolerant by treatment with 0.5 mMGTN for 30 min. Data points represent the mean±standard deviation(n=3-6).

FIG. 13(A-B) is a graph showing the effect of Vm and Va in the mousewrithing test. GT Vm produced a dose-dependent analgesic effect (A). Vaalso produced analgesia in the mouse writhing test (B). Data are mean istandard errors (n=10-20).

FIG. 14(A-B) is a graph showing the effect of Vm on paw flinches in ratsafter injection of formnalin into the footpad. In comparison tovehicle-treated control animals, Vm decreased the initial pain responseto formalin injection (at time=0, *, p<0.05), and the secondaryhyperalgia that developed between 20 and 40 minutes after formnalininjection (A). For each animal, a cumulative score (total number offlinches over 60 minutes) was calculated (B). Vm significantly decreasedcumulative paw flinches for 60 minutes after formalin injection. Dataare mean i standard errors (N=6-7).

FIG. 15(A-B) is a graph showing (A) the effects of chlormethiazole(CHLOR) and WVk (200 μM of each) on the membrane current induced by 10jiM GABA in a Xenopus oocyte expressing the α1β1γ2L isoform of humanrecombinant GABAA receptors, and (B) the effect of IVk on loss of therighting reflex in mice after intraperitoneal injection of 100 mg/kg and200 mg/kg. Data in part B are mean +standard error for three animals ateach dose.

DETAILED DESCRIPTION OF THE INVENTION

In accordance with the invention there are provided methods andcompositions useful in the treatment of pain. Methods of the inventioninvolve administering to a subject an effective amount of a therapeuticcompound which provides analgesia, mitigates inflammation and/orprovides sedation. In some embodiments, the invention providesprophylactic methods for avoiding or pre-empting pain, inflammation andthe like in a subject. For example, the subject may be susceptible orpredisposed to these conditions, e.g., arthritic. Alternatively, thesubject may be undergoing a course of treatment, e.g. cancerchemotherapy, which produces pain, inflammation or the like as a sideeffect. Methods of the invention may be practiced prior to, concurrentlywith, or after such a course of treatment.

In accordance with the invention, analgesic, anti-inflammatory and/orsedative activity can be effected by modulating an interaction withguanylyl cyclase (GCase; the enzyme responsible for cGMP production invarious areas of the body), and/or by modulating levels of cGMP and cAMPmessenger molecules.

As used herein, the term “treating” pain encompasses preventing,ameliorating, mitigating and/or managing pain and/or conditions that maycause pain, such as inflammation. As used herein, “inhibiting” pain orinflammation encompasses preventing, reducing and halting progression ofsame. The terms “organic nitrate” and “nitrate ester” are usedinterchangeably herein, with no distinction drawn between them.

According to one aspect of the invention, there is provided a method fortreating pain in a subject, comprising administering to the subject aneffective amount of a compound (nitrate ester) which effects analgesiain the subject. Preferably, analgesia is effected by stimulating GCase.In vivo, GCase activation is effected by nitric oxide (NO), the proximalactivator of GCase, which is generated endogenously by enzyme action onarginine in response to many biological triggers (J. R. Stone and M. A.Marletta, Biochemistry (1996) 35, 1093). One of the major targets fororganic nitrates is GCase activation, resulting in the production ofcGMP. In this respect, organic nitrates act as NO-surrogates. In somecases, there is evidence that organic nitrates may act also asNO-donors, but these two properties should be differentiated and can bemodulated by choice of the appropriate organic nitrate.

Experimental evidence obtained in a number of in vivo model systemssupports the notion that elevated levels of cGMP help effect analgesia.Sodium nitroprusside (SNP), which releases NO non-enzymatically, blockedthe hyperalgesic effect of prostaglandin (PGE₂) in a rat paw pressuretest (Ferreira et al., 1991). Moreover, this effect was potentiated byan inhibitor of cGMP phosphodiesterase, and blocked by an inhibitor ofGCase (Ferreira et al., 1991). The peripheral analgesic effects ofmorphine were attributed to elevations of cGMP levels in sensory nervefibres (Ferreira et al., 1991; Granados-Soto et al., 1997) in both therat paw pressure and formalin tests, since inhibition of GCase activityattenuated the analgesic effects of locally applied morphine. Activationof the NO-cGMP system by NO donors such as SNP has also been reported topotentiate beta-endorphin-induced analgesia in thermal tail-flick testin mice (Xu et al., 1995), an effect that was potentiated by a selectiveinhibitor (zaprinast) of a cGMP-specific phosphodiesterase.

Sensitization of sensory nerve fibres leading to hyperalgesia is assumedto involve increased concentrations of cAMP and calcium ions in sensoryneurons, a process that may be attenuated or counteracted by activationof the NO-cGMP pathway (Ferreira, 1993; Cunha et al., 1999).

In accordance with another embodiment of the invention, administrationof an effective amount of a therapeutic compound to a subject effectsanalgesia in the subject by modulating levels of cAMP and/or cGMP. Forexample, it has been shown that NO-donors modulate hyperalgesia viamodulation of levels of cAMP, separately from and in addition tomodulation of cGMP levels, in rat models of pain and nociceptorsensitization (Aley et al. 1998). Thus, modulation of cAMP/cGMP levelsis expected to be effective in inducing analgesia and in pain managementin individuals suffering injury, disease or aging.

In a futher embodiment of the invention, there is provided a method fortreating or hibitng imflammation in a subject, comprising administeringto the subject an effective amount of a compound which mitigatesinflammation in the subject. Preferably, inflammation is mitigated bymodulation of levels of cGMP/cAMP. Inflammatory hyperalgesia has beenshown to be linked directly to the NO-cGMP pathway (Ferreira, 1993).

We have shown in our co-pending application U.S. Ser. No. 09/267,379,filed Mar. 15, 1999, now U.S. Pat. No. 6,310,052, which is herebyincorporated by reference, that novel nitrate esters have differentialeffects to activate soluble GCase and to cause cGMP accumulation invascular and brain tissue. Further, we have shown that the structure ofthe organic nitrate can be varied to alter potency and efficacy towardsboth activation of GCase and accumulation of cGMP and effects resultingfrom these processes in intact tissue, such as aortic strip relaxation.Activation of GCase and accumulation of cGMP have been shown to beimportant in the induction of analgesia. We show herein that novelorganic nitrates are effective analgesics in animal models of painmanagement. The mouse writhing model, with a relatively short timecourse of minutes, is a preclinical model of acute pain; whereasformalin injection in the rat paw is a preclinical model of acute andsensitization pain with a time course of minutes to hours, whicheffectively mnimics the hyperalgesia/allodynia underlying pain due totissue damage (Yaksh, 1999).

In a further embodiment, the invention relates to a method for providingsedation and/or anaesthesia in a subject, comprising administering tothe subject an effective amount of a compound (organic nitrate) whicheffects sedation or anaesthesia in the subject. In certain aspects, theinvention provides methods and compositions useful for reducing anxiety,and/or aiding or inducing sleep.

γ-Aminobutyric acid (GABA) is the major inhibitory neurotransmitter inthe mammalian (including human) central nervous system. GABA acts onthree major classes of neurotransmitter receptor, designated type A(GABA_(A)), type B (GABA_(B)) and type C (GABA_(C)). GABA_(A) receptorsplay an important role in regulating many behavioural and physiologicalfunctions. Thus, drugs that modulate GABA_(A) receptor function areamong the most widely used in clinical medicine. For example, drugs thatselectively potentiate GABAA receptor function (such as thebenzodiazepines) are extensively used to relieve anxiety, producesedation and induce sleep. Given the importance of this receptormechanism in clinical medicine, there is a constant search for newchemical entities that modulate GABA_(A) function, as the currentlyavailable drugs have several side effects, including ataxia, amnesia,tolerance and physical dependence. We show herein that organic nitratesthat act as positive allosteric modulators of GABA_(A) receptor functionhave sedative properties in the whole animal that are comparable toknown drugs. This effect of organic nitrates has not previously beenrecognized or reported. Our findings provide direct evidence thatnitrate esters are useful as sedative agents. Such agents are useful astherapeutics for treating conditions such as, for example, anxiety andpain associated with disease states; and as hypnotic agents. Accordingto the invention, nitrate esters may also be employed prophylactically,to prevent or reduce anxiety, or to aid sleep.

Therapeutic compounds of the invention comprise at least one nitrategroup. The nitrate groups(s) can optionally be covalendy bound to acarrier (e.g., an aromatic group, an aliphatic group, peptide, steroid,nucleobase, nucleoside, peptidomimetic, steroidomimetic, or nucleosideanalogue, or the like). In addition to functioning as a carrier for thenitrate functionality, the carrier molecule can enable the compound totraverse biological membranes and to be biodistributed preferentially,without excessive or premature metabolism. Further, in addition tofunctioning as a carrier for the nitrate functionality, the carriermolecule can enable the compound to exert amplified analgesic, sedative,or anti-inflammatory effects through synergism with the nitratefunctionality.

In one embodiment, the invention provides a method comprisingadministering to a subject an effective amount of a therapeutic compoundwhich has at least one nitrate group and is capable of effectinganalgesia. In another embodiment, the therapeutic compound is capable ofmitigating inflammation. In a further embodiment, the therapeuticcompound is capable of effecting sedation. In the respectiveembodiments, the therapeutic compound has the formula (Formula I):

wherein: E, F¹, F², G¹, G² are the same or different organic radicalswhich may be joined in cyclic ring systems, and which may containinorganic counterions.

In further aspects of the invention, therapeutic compounds of theinvention effect analgesia, effect sedation and/or mitigate inflammationin a subject to which the therapeutic compound is administered, and havethe formula (Formula II).

in which: m, n, p are integers from 0 to 10; R^(3,17) are eachindependently hydrogen; a nitrate group; or A; R^(1,4) are eachindependently hydrogen; or A; where A is selected from: a substituted orunsubstituted aliphatic group (preferably a branched, or straight-chainaliphatic moiety having from 1 to 24 carbon atoms in the chain, whichoptionally may contain O, S, NR⁶ and unsaturations in the chain,optionally bearing from 1 to 4 hydroxy, or nitrate, or amino or aryl, orheterocyclic groups; an unsubstituted or substituted cyclic aliphaticmoiety having from 3 to 7 carbon atoms in the aliphatic ring, whichoptionally may contain O, S, NR⁶ and unsaturations in the ring,optionally bearing from 1 to 4 hydroxy, or nitrate, or ammno or aryl, orheterocyclic groups; an unsubstituted or substituted aliphatic moietyconstituting a linkage of from 0 to 5 carbons, between R¹ and R³ and/orbetween R¹⁷ and R⁴, which optionally may contain O, S, NR⁶ andunsaturations in the linkage, and optionally bearing from 1 to 4hydroxy, or nitrate, or amino or aryl, or heterocyclic groups); asubstituted or unsubstituted aliphatic group (preferably a branched,cyclic or straight-chain aliphatic moiety having from 1 to 24 carbonatoms in the chain), containing carbonyl linkages (e.g., C═O, C═S,C═NOH), which optionally may contain O, S, NR⁶ and unsaturations in thechain, optionally bearing from 1 to 4 hydroxy, or nitrate, or ammno oraryl, or heterocyclic groups; a substituted or unsubstituted aryl group;a heterocyclic group; amino (including alkylamino, dialkylamino, such ascyclic amino, diamino and triamnuo moieties), arylamifno, diarylamnino,and alkylarylarnino); hydroxy; alkoxy; a substituted or unsubstitutedaryloxy ; R², R⁵, R¹⁸, R¹⁹ are optionally hydrogen; or A; or X-Y; whereX is F, Br, Cl, NO₂, CH₂, CF₂, O, NH, NMe, CN, NHOH, N₂H₃, N₂H₂R¹³,N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(R¹⁵)₂, SCN₂H₃(R¹⁵), SC(O)N(R¹⁵)₂,SC(O)NHR1⁵, SO₃M, SH, SR⁷, SO-M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)20R⁹,PO₂HM, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR1⁶)(OM), P(O)(R¹⁵)(OR8),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹, C(O), C(O)R¹², C(O)(OR1³), PO₂H, PO2M,P(O)(OR¹⁴), P(O)(R¹³), SO, SO₂, C(O)(SR¹³), SR⁵, SSR⁷ or SSR⁵; Y is F,Br, Cl, CH₃, CF₂H, CF₃, OH, NH₂, NHR⁶, NR⁶R⁷, CN, NHOH, N₂H₃, N₂H₂R¹³,N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(R¹⁵)₂, SCN₂H₃(R¹⁵), SC(O)N(R¹⁵)₂,SC(O)NHR1⁵, SO₃M, SH, SR⁷, SOM, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸, S(O)₂O R⁹,PO₂HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R15)(OR8),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O)R¹², C(O)(OR1³), C(O)(SR¹³), SR⁵,SSR⁷ or SSR⁵, or does not exist; R⁶, R⁷, R⁸, R⁹, R¹⁰, R¹¹, R¹², R¹³,R¹⁴, R¹⁵, R¹⁶ are the same or different alkyl or acyl groups containing1-24 carbon atoms which may contain 1-4 ONO₂ substituents; or C₁-C₆connections to R¹-R⁴ in cyclic derivatives; or are each independentlyhydrogen; a nitrate group; or A; M is H, Na+, K+, NH₄+, N⁺H_(k)R¹¹ wherek is 0-3, or other pharmaceutically acceptable counterion.

Preferred therapeutic compounds for use in the invention includecompounds in which R¹⁹ is X-Y. In a particularly preferred embodiment:R¹⁹ is X-Y and R⁵, R⁶, R⁸, R⁹, R¹⁰, R¹², R¹³, R¹⁴, R¹⁵, 19 R¹⁶ are thesame or different alkyl groups containing 1-24 carbon atoms which maycontain 1-4 ON02 substituents, or Cl or C2 connections to R¹-R³ incyclic derivatives; R¹ and R³ are the same or different and selectedfrom H, Cl-C₄, alkyl chains, which may inlude one 0, linking R¹ and R³to form pentosyl, hexosyl, cyclopentyl, or cycohexyl rings, which ringsmay optionally bear hydroxyl substituents; R² and R⁴, are the same ordifferent and selected from H, a nitrate group, Cl-C₄ alkyl optionallybearing 1-3 nitrate group, and acyl groups (-C(O)R⁵); R⁷, R¹¹ are thesame or different Cl - C₈, a,l or acyl.

In certain embodiments in which Rig is X-Y, m, p=1, and n=0. In otherembodiments in which Rig is X-Y, X is selected from CH₂, O, NH, NMe, CN,NHOH, N₂H₃, N₂H₂R¹³, N₂HR¹³R¹⁴, N₃, S, SCN, SCN₂H₂(R⁵)₂, SCN₂H₃(R¹⁵),SC(O)N(RI⁵)₂, SC(O)NHR¹⁵, SO₃M, SH, SR⁷, SO?M, S(O)R⁸, S(O)₂R⁹, S(O)OR⁸,S(O)₂O R⁹, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM),P(O)(R¹⁵)(ORB), P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹¹, C(O), C(O)R¹²,C(O)(OR¹³), PO₂M, P(O)(OR¹⁴), P(O)(R¹³), SO, SO₂, C(O)(SR¹³), SSR⁴. Inanother embodiment in which Rig is X-Y, Y is selected from CN, N₂H₂R¹³,N₂HR1³R¹⁴, N₃, SCN, SCN2H2(R¹⁵)2, SC(O)N(R¹⁵)2, SC(O)NHR¹⁵, SO₃M, SR⁴,SO?M, PO₃HM, PO₃M₂, P(O)(OR¹⁵)(OR¹⁶), P(O)(OR¹⁶)(OM), P(O)(R¹⁵)(OR8),P(O)(OM)R¹⁵, CO₂M, CO₂H, CO₂R¹l, C(O)R¹², C(O)(SR¹³), SR⁵, SSR⁵, or doesnot exist. In a further embodiment, X and/or Y contain asulfur-containing functional group. In certain preferred embodiments,the compound of the invention comprises a heterocyclic functionality,more preferably, a nucleoside or nucleobase. In further preferredembodiments, the compound of the invention comprises a carbocyclicfunctionality, more preferably, a steroidal or carbohydrate moiety.

In another aspect of the invention, a therapeutic compound of theinvention is represented by the formula (Formula III):

in which: m, n are 1-10; R¹-¹⁸, X, and Y have the meaning as definedabove. In certain preferred embodiments, R⁶ - R¹⁶ are the same ordifferent alkyl or acyl groups containing 1-24 carbon atoms which maycontain 1-4 ON0₂ substituents, or C₁-C₆ connections to R¹-R⁴ in cyclicderivatives. In certain preferred embodiments, R¹⁸ is A and m=n=1. Infurther preferred embodiments, therapeutic compounds of the inventionhave a formula selected from (Formulae IIIa-IIIam):

In a further aspect of the invention, a therapeutic compound of theinvention is represented by the formula (Formula IV):

in which n=0, X is CH₂ or does not exist, and Y is selected from, F, Br,Cl, CH₃, CF₂H, CF₃, OH, NH₂, NHR6, NR6R₇, CN, NHOH, N₂H₃, N₂H₂R₁₃,N₂HR₁₃R₁₄, N₃, S, SCN, SCN₂H₂(R₁₅)₂, SCN₂H₃(R¹⁵), SC(O)N(R¹⁵)2,SC(O)NHRi₅, SO₃M, SH, SR₇, SO-M, S(O)Rg, S(O)₂R₉, S(O)ORg, S(O)₂O R₉,PO₂HM, PO₃M₂, P(O)(OR₁₅)(OR₁₆), P(O)(OR₁₆)(OM), P(O)(Ri5)(OR8),P(O)(OM)R15, CO₂M, CO₂H, CO₂R₁l, C(O)RI₂, C(O)(OR₁₃), C(O)(SR₁₃), SR₅,SSR₇ or SSR₅. R₂, R₄, R₅, R6, R₇, Rg, Rg, Rio, Ril, R₁₂, R₁₃, R₁₄, R₁₅,and R₁₆ are as defined above. In certain preferred embodiments, R₂ andR₄ are optionally H, a nitrate group or a connection to R₅-R₁₆ in cyclicderivatives.

In certain preferred embodiments, a compounds of the invention isrepresented by the formula (Formulae IVa-IVt):

In a further aspect of the invention, compounds according to theinvention are represented by the formula (Formula V):

in which R₂ is optionally H or a connection to R₅ in cyclic derivatives,R₄ is H or a nitrate group, and R₅ is as described above.

In certain preferred embodiments, compounds of the invention arerepresented by the formula (Formulae Va-Vag):

In another aspect, the invention provides novel compounds which can berepresented by structures of Formula III, Formula IV, and Formula V.Table 1 lists data associated with these compounds using art-recognizedcharacterization techniques. Further, the invention provides novelpharmaceutical compositions comprising a therapeutic compound (nitrateester) of the invention and a pharmaceutically acceptable vehicle. TABLE1 ¹H NMR ¹³C NMR IIIa (CDCl₃): 5.34-5.57(1H, dm, ³J_(HF) 20.6), (CDCl₃):79.47(d, ¹J_(CF) 177), 4.53-4.87(4H, superposition several multiplets,O₂NO—CH ₂+CH ₂F, 76.73(d, ²J_(CF) 20.6), 67.84(d, ²J_(HF) 46.7, ⁴J_(HF)0.66) ³J_(CF) 6.87) IIIc (CDCl₃): δ 5.7(1H, t, ²J_(HF) 54), 5.45(1H, m),(CDCl₃): δ 75.55, 68.05, 60.76 4.5-4.9(2H, m), 4.15-4.35(1H, m) IIId(CDCl₃): δ 5.46(1H, m), 4.80-4.87(1H, dd, J 3.5, (CDCl₃): δ 77.24,68.57, 39.86 12.9), 4.65-4.72(1H, dd, J 6.2, 12.9), 3.7-3.8(2H, m) IIIf(CDCl₃) δ 8.72(s, 1H), 5.38(t, 1H), 4.6(d, 2H), — 2.45(s, 3H) IIIg(DMSOd₆) CHONO₂ only: δ 4.8-5.8 (DMSOd₆) CONO₂ only: δ 85.68, 84.17,82.47, 76.50 IIIh (CD₃OD) δ 4.85(3H, m), 3.5(1H, m) (CD₃OD) δ 70.61,36.74 IIIi (CDCl₃): δ 6.95(dd, 1H), 6.71(dd, 1H), 6.09(m, (CDCl₃): δ137.9, 132.5, 76.6, 1H), 3.80(dd, 1H), 3.32(dd, 1H) 52.9 IIIj (CDCl₃): δ5.62(2H, m), 3.60(4H, m) (CDCl₃): δ 77.87, 25.22 IIIk (CD₃CN): δ 3.45(m,2H), 5.72(m, 2H) (CD₃CN): δ 79.98, 28.87 IIIl — (CD₃CN): δ 79.48, 33.45,28.47 IIIm (DMSOd₆): δ 5.97(m, 2H), 3.80(m, 4H) (DMSOd₆): δ 78.84, 52.60IIIn (CDCl₃): δ 5.73(m, 1H), 4.62(m, 1H), 3.96-3.77(m, (CDCl₃): δ 81.47,57.85, 53.50, 1H), 3.58-3.32(m, 1H) 38.75 IIIo — (CDCl₃): δ 81.24,69.79, 33.26, 27.24 IIIp (CDCl₃): δ 5.36(m, 1H), 3.11-3.60(m, 4H),2.33(m, (CDCl₃): δ 78.92, 33.66, 30.64, 2H) 27.36 IIIq (CDCl₃): δ5.47(m, 1H), 3.53-3.05(m, 4H), 2.29(m, (CDCl₃): δ 81.32, 37.12, 32.97,2H) 30.98 IIIw (CDCl₃, 300MHz): 5.31-5.45(m, 1H), 3.92-4.08(m, (CDCl₃,75MHz): 76.83, ³¹P(CDCl₃, 162MHz) 4H), 3.63-3.81(m, 2H), 2.03-2.30(m,2H), 62.15(d, J 6.37), 43.77(d, J 8.95), 24.60 1.16-1.24(superpositionof 2 t, 6H, J 7) 27.08(d, J 142.00), 15.99(d, J 5.88) IIIx ³¹P(CD₃OD,(CD₃OD, 300MHz): 5.38-5.63(m, 1H), (CD₃OD, 75MHz): 81.14, 122MHz) 17.623.75-4.25(superposition of 2 m, 4H), 1.88-2.20(m, 2H), 61.17(d, J 5.41),45.56(d, J 1.12-1.28(t, 3H) 5.94), 29.35(d, J 131.74), 17.00(d, J 6.75)IIIak ¹H(CD₃CN, 300MHz): 7.8(s, 1H), 5.75-5.85(m, ¹³C(CD₃CN, 75MHz) (for1H), 4.90-4.97(dd, 1H, J 12.87, 3.39), 4.54-4.76(m, polynitrated chain):78.51, 3H), 3.46(s, 3H), 3.27(s, 3H) 70.58, 46.01, 30.10, 28.18 Ivi(CDCl₃): δ 5.45(1H, m), 4.83(1H, dd), 4.65(1H, (CD₃OD): δ 116.44, 75.37,dd), 2.9(2H, m) 71.20, 19.19 Ivk (CDCl₃) δ 8.55(s, 1H), 4.55(t, 2H),3.15(t, 2H), (CDCl₃) δ 150.9, 150.7, 125.3, 2.37(s, 3H) 72.53, 24.47,15.18 Ivm (CDCl₃): δ 7.5-8.0(arom, 5H), 5.7(1H, m), (CDCl₃): δ 135.45,134.79, 4.94(1H, dd), 4.62(1H, dd), 3.5(2H, m) 129.81, 27.95, 73.08,70.04, 54.73 Ivs 1H-NMR(CDCl3, 300MHz): 5.23-5.32(1H, m), 13C-NMR:(CDCl3, 75.48MHz): 4.87(1H, dd, J 12.82, 3.22), 4.68(1H, dd, J 12.83,79.39, 69.30, 23.68 6.09), 2.77-2.94(2H, m), 1.66(1H, t, J 9.07) Ivt1H-NMR(CDCl3, 300MHz): 5.29-5.38(1H, m), 13C-NMR: (CDCl3, 75.48MHz):4.76(1H, dd, J 12.94, 3.11), 4.55(1H, dd, J 12.94, 194.10, 77.00, 69.79,6.37), 3.30(1H, dd, J 14.06, 5.98), 3.13(1H, dd, J 30.42, 27.78 14.61,6.35) Vb (CDCl₃) δ 5.56(m, 2H), 3.38-2.95(m, 4H) (CD₃OD) δ 85.93, 32.77Vc (CDCl₃): δ 5.85-5.91(1H, m), 4.50-4.58(1H, m), (CDCl₃): δ 87.6,74.96, 36.20, 3.22-3.29(1H, dd, J 5.47, 12.78), 2.97-3.05(1H, dd, 31.54J 4.6, 11.88), 2.82-2.90(1H, dd, J 2.87, 12.78), 2.74-2.83(1H, dd, J3.15, 11.9) Ve (CDCl₃): δ 7.44-7.51(m, arom 2H), 7.17-7.24(d, (CDCl₃): δ21.53, 36.78, 69.82, arom 2H, J 7.91), 5.47-5.59(m, 1H), 4.83-4.93(dd,77.68, 130.52, 130.62, 132.55, 1H, J 12.81, 2.78), 4.57-4.67(dd, 1H, J12.82, 5.71), 139.23 3.02-3.12(dd, 1H, J 14.48, 6.01), 2.9-2.99(dd, 1H,J 14.47, 7.72), 2.38(s, 3H) Vf (CDCl₃): δ 7.48-7.57(m, arom 2H),7.48-7.57(m, (CDCl₃): δ 36.57, 55.87, 69.75, arom 2H), 5.49-5.59(m, 1H),4.84-4.93(dd, 1H, J 77.76, 115.47, 126.71, 133.76, 12.79, 2.79),4.58-4.68(dd, 1H, J 12.79, 5.75), 160.94. 3.84(s, 3H), 3.02-3.12(dd, 1H,J 14.47, 5.8), 2.89-2.99(dd, 1H, J 14.46, 7.99). Vg (CDCl₃): δ7.47-7.54(m, arom 2H), 7.32-7.38(m, (CDCl₃): δ 36.87, 69.80, 77.5, arom2H), 5.45-5.55(m, 1H), 4.84-4.97(dd, 1H, J 129.98, 130.85, 134.51,134.79. 12.86, 2.92), 4.58-4.68(dd, 1H, 12.86, 5.68), 2.91-3.11(m, 2H).Vh (CDCl₃): δ 8.21-8.27(m, arom 2H), 7.67-7.74(m, (CDCl₃): δ 37.24,69.75, 77.41, arom 2H), 5.44-5.54(m, 1H), 4.86-4.94(dd, 1H, J 124.82,127.26, 144.83 12.92, 3.11), 4.61-4.70(dd, 1H, J 12.92, 5.56),3.01-3.16(m, 2H). Vi (CDCl₃): δ 7.40-7.55(m, arom 4H), 5.44-5.55(m,(CDCl₃): δ 36.87, 69.79, 77.48, 1H), 4.85-4.92(dd, 1H, J 12.87, 2.91),4.60-4.70(dd, 122.72, 130.93, 132.90, 135.15. 1H, J 12.86, 5.66),2.92-3.11(m, 2H). Vj (CDCl₃): δ 7.55-7.62(d, arom 2H, J 7.16), (CDCl₃):δ 36.97, 69.88, 77.61, 7.29-7.44(m, arom 3H), 5.46-5.58(m, 1H),4.82-4.92(dd, 128.60, 129.50, 129.85, 136.02 1H, J 12.85, 2.79),4.57-4.67(dd, 1H, J 12.86, 5.67), 3.01-3.13(dd, 1H, J 14.51, 6.24),2.92-3.02(dd, 1H, J 14.52, 7.4) Vk (CDCl3, 300MHz): 8.09(1H, dd, J 8.12,0.36), (CDCl3, 75.48MHz): 166.21, 8.02(1H, dd, J 7.8, 1.15),7.51-7.59(1H, m, J 7.24, 1.44), 140.41, 132.78, 131.46, 127.63,7.21-7.29(1H, m, J 7.35, 0.54), 5.40-5.49(1H, m), 125.48, 77.25, 71.03,61.42, 4.70-4.78(1H, dd, J 13.04, 2.95), 4.33-4.45(3H, m, 32.51, 28.29,14.17 superposition of 1H from CH2—ONO2 and quartet from O—CH2—CH3),2.66-2.87(2H, quartet, J 6.92), 1.39(3H, t, J 7.14) Vl (CDCl₃, 300MHz):δ 7.97(s, 1H), 7.48-7.51(d, 1H), (CDCl₃, 75.48MHz): δ 14.17,7.17-7.22(m, 1H), 6.84-6.89(d, 1H), 6.05(s, 2H), 36.27, 62.15, 69.71,76.57, 5.48-5.58(m, 1H), 4.81-4.89(dd, 1H), 4.53-4.61(dd, 101.77,108.27, 110.31, 125.20, 1H), 4.25-4.4(m, 2H), 3.05-3.10(m, 2H), 127.55,127.87, 146.87, 147.811, 1.35-1.45(t, 3H). 149.76, 165.89 Vm (CDCl₃,300MHz): δ 8.04-8.11(m, arom 2H), (CDCl₃, 75.48MHz): δ 14.17,7.55-7.62(m, arom 1H), 7.30-7.34(m, arom 1H), 26.23, 35.95, 61.55,69.54, 5.43-5.54(m, 1H), 4.88-4.97(dd, 1H, J 12.95, 2.79), 77.24,125.56, 125.92, 127.91, 4.62-4.71(dd, 1H, J 12.94, 5.35), 4.45-4.39(q,2H, 131.52, 132.93, 139.56, 166.189 J 7.12), 2.92-3.08(m, 2H),1.39-1.47(t, 3H, J 7.13) Vn (CDCl₃, 300MHz): δ 8.92-8.97(m, arom 1H),(CDCl₃, 75.48MHz): δ 36.06, 8.07-8.23(m, arom 2H), 7.46-7.77(m, arom3H), 69.62, 70.24, 77.42, 121.97, 5.53-5.62(m, 1H), 4.91-4.99(dd, 1H, J12.98, 2.77), 125.65, 126.43, 126.70, 128.52, 4.61-4.7(dd, 1H, J 12.98,5.35), 3-3.18(m, 2H) 135.31, 136.37, 145.62, 149.65 Vo (CDCl₃, 300MHz):δ 7.55-7.59(m, arom 1H), (CDCl₃, 75.48MHz): δ 37.10, 7.40-7.45(m, arom1H), 7.25-7.36(m, arom 2H), 69.87, 77.44, 126.80, 128.38, 5.45-5.55(m,1H), 4.85-4.95(dd, 1H, J 12.98, 3), 128.52, 130.83, 135.76, 138.014.59-4.69(dd, 1H, J 12.89, 6.67), 2.95-3.12(m, 2H) Vp (CDCl₃, 300MHz): δ7.65-7.67(d, arom 1H J 2.15), (CDCl3 75.48MHz): δ 36.59, 7.44-7.47(d,arom 1H, J 7.42), 7.28-7.49(m, arom 69.32, 76.90, 127.49, 129.86, 1H),5.46-5.54(m, 1H), 4.87-4.94(dd, 1H, J 12.89, 131.04, 132.31, 133.59,135.65 2.99), 4.61-4.68(dd, 1H, J 12.88, 5.65), 2.95-3.12(m, 2H) Vq(CDCl₃, 300MHz): δ 7.2-7.6(m, arom 8H), 5.42-5.56(m, 2H), 4.82-4.95(dd,2H), 4.55-4.67(dd, 2H), 2.93-3.15(m, 4H) Vr (CDCl3, 300MHz): δ 8.63(s,arom 1H), 8.01-8.13(m, arom 2H), 7.57-7.65(m arom 1H), 7.26-7.37(m, arom1H), 5.42-5.51(m, arom 1H), 4.88-4.97(dd, 1H, J 12.9, 2.7),4.62-4.71(dd, 2H, J 12.9, 5.1), 4.49-4.57(t, 2H, J 6.6), 3.23-3.32(t,2H, J 6.6), 2.91-3.08(m, 2H), 2.45(s, 3H) Vs (d₆-acetone), 300MHz):8.16-8.23(1H, d, J 7.72), (d₆-acetone, 100.62MHz): 8.07-8.13(1H, dd, J7.72, 1.11), 7.63-7.72(1H, m, J 167.74, 134.01, 132.64, 126.62, 8.38,1.26), 7.33-7.42(1H, m, J 7.33), 5.67-5.76(1H, 126.21, 78.90, 71.69,36.79 m), 5.09-5.17(1H, dd, J 12.91, 2.68), 4.83-4.93(1H, dd, J 12.91,5.91), 3.18-3.32(2H, m) Vt (CDCl₃, 300MHz): δ 7.53-7.59(d, arom 1H, J8.35), (CDCl₃, 75.48MHz): δ 19.01, 7.46-7.49(d, arom 1H, J 1.82),7.37-7.43(m, arom 37.10, 70.01, 77.46, 115.27, 1H), 6.24(s, 1H),5.46-5.55(m, 1H), 4.86-4.94(dd, 115.34, 119.52, 123.07, 125.83, 1H,12.92, 2.92), 4.61-4.69(dd, 1H, J 12.93, 5.75), 141.13, 152.38, 154.25,160.51 3.0-3.15(m, 2H), 2.42(s, 3H) Vu (CDCl₃, 300MHz): δ 7.55-7.58(m,arom 1H), (CDCl3, 75.48MHz): δ 7.40-7.45(m, arom 1H), 7.27-7.32(m, arom2H), 37.08, 69.83, 77.40, 126.80, 5.46-5.54(m, 1H), 4.86-4.94(dd, 1H, J12.88, 2.92), 128.40, 128.54, 130.83, 4.59-4-68(dd, 1H, J 12.88, 5.65),2.95-3.13(m, 2H) 135.78, 137.98 Vv (CDCl₃, 300MHz): 8.09-8.14(1H, d, J8.15), (CDCl₃, 75.48MHz): 166.34, 7.98-8.04(1H, dd, J 7.75, 0.91),7.52-7.59(1H, m, J 8.22, 140.25, 132.90, 131.49, 127.67, 1.19),7.22-7.28(1H, m, J 7.65), 4.53-4.61(1H, dd, J 125.60, 74.34, 66.83,61.53, 11.33, 3.63), 4.42-4.50(1H, m, J 11.33, 6.27), 40.89, 14.204.32-4.41(2H, qu., J 7.13), 4.16-4.25(1H, m), 2.74-2.84(2H, m),2.55-2.73(1H, br.s.), 1.34-1.42(3H, t, J 7.13) Vx (CDCl₃, 300MHz): δ5.49-5.61(m, 1H), (CDCl₃, 75.48MHz): δ 17.39, 4.88-4.90(m, 1H),4.62-4.74(m, 1H), 4.40-4.55(m, 1H), 25.20, 29.40, 36.41/36.51,3.59-3.78(m, superpos. 5H), 2.69-3.21(m, superpos. 38.55, 41.94/42.19,47.32, 5H), 2.14-2.29(m, 1H), 1.90-2.12(m, 3H), 52.56, 59.12,1.22-1.28(d, 3H) 69.90/70.29, 77.89/78.00, 173.01, 173.48 Vy (CDCl₃,300MHz): δ 8.5(s, 1H), 2.94-3.02(t, (CDCl₃, 75.48MHz): δ 15.41, 2H),2.62-2.72(q, 2H), 2.33(s, 3H), 1.38-1.45(t, 26.41, 31.51, 39.72, 129.36,1H). 149.90 Vz (CD₃CN, 300MHz): 4.60-4.68(1H, dd, J 11.44, (CD₃CN,75.48MHz): 76.33, 3.36), 4.43-4.52(1H, dd, J 11.35, 6.97), 67.34, 42.744.11-4.21(1H, m), 2.80-3.00(2H, m) Vaa (CDCl₃, 300MHz): δ 8.05-8.15(m,arom 2H), (CDCl₃, 5.48MHz): δ 36.42, 7.55-7.65(m, arom 1H), 7.25-7.35(m,arom 1H), 52.87, 69.98, 77.69, 126.07, 5.40-5.55(m, 1H), 4.85-4.95(dd,1H), 4.60-4.70(dd, 1H), 126.45, 128.01, 132.06, 133.53, 3.95(s, 3H),2.90-3.10(m, 2H) 140.161, 167.10 Vab (CDCl₃, 300MHz): δ 7.30-7.39(m,arom 5H), (CDCl₃, 75.48MHz): δ 32.01, 5.28-5.37(m, 1H), 4.72-4.78(dd,1H, J 12.86, 2.79), 35.997, 43.66, 69.89, 77.72, 4.45-4.53(dd, 1H, J12.86, 5.9), 3.95(s, 2H), 128.33, 129.22, 129.81, 137.22 2.44-2.52(dd,1H, J 14.38, 6.1), 2.33-2.42(dd, 1H, J 14.38, 7.34) Vac 1H-NMR(CDCl3,300MHz): 5.48-5.58(1H, m), 13C-NMR: (CDCl3, 75.48MHz): 4.89(1H, ddd, J12.91, 2.91, 1.21), 4.56-4.70(2H, 77.30, 74.22, 69.46, m), 4.48(1H, dd,J 11.41, 6.4), 4.16-4.26(1H, m), 69.38, 66.90, 66.78, 42.12,2.94-3.12(2H, m), 2.81-2.91(2H, m) 41.99, 36.82, 36.59 Vad (CDCl₃,400MHz): 5.55-5.65(m, 1H), (CDCl₃, 400MHz): 76.74, 4.87-4.94(dd, 1H, J12.94, 2.94), 4.62-4.70(m, 1H, J 12.88), 69.46/69.42, 36.65/36.633.13-3.30(m, 2H)

It will be noted that the structure of some of the compounds of thisinvention include asymmetric carbon atoms. It is to be understoodaccordingly that the isomers (e.g., enantiomers, diastereomers) arisingfrom such asymmetry are included within the scope of this invention.Such isomers can be obtained in substantially pure form by classicalseparation techniques and by asymmetric synthesis (for example, seebelow in Example 21). Unless expressly noted to the contrary, compoundsreferred to herein shall be construed to include both the R and Sstereolsomers at each stereogenic centre.

In certain embodiments, a therapeutic compound of the inventioncomprises a cation (i.e., in certain embodiments, one of X or Y includesa cation, e.g., in the compound of formula IVd). If the cationic groupis a proton, then the compound is considered an acid. If the proton isreplaced by a metal ion or its equivalent, the compound is a salt.Pharmaceutically acceptable salts of the therapeutic compound are withinthe scope of the invention. For example, M can be a pharmaceuticallyacceptable alkali metal (e.g., Li, Na, K), ammonium, alkaline earthmetal (e.g., Ca, Ba, Mg), higher valency cation, or polycationic counterion (e.g., polyammonium cation) (see e.g., Berge et al. (1977)). It willbe appreciated that the stoichiometry of an anionic portion of thecompound to a salt-forming cation will vary depending on the charge ofthe anionic portion of the compound and the charge of the counterion.Preferred pharmaceutically acceptable salts include a sodium, potassium,or calcium salt, but other salts are also contemplated within theirpharmaceutically acceptable range.

Therapeutic compounds of the invention can be administered in apharmaceutically acceptable vehicle. As used herein “pharmaceuticallyacceptable vehicle” includes any and all solvents, excipients,dispersion media, coatings, antibacterial and antifuangal agents,isotonic and absorption delaying agents, and the like which arecompatible with the activity of the compound and are physiologicallyacceptable to the subject. An example of a pharmaceutically acceptablevehicle is buffered normal saline (0.15 M NaCi). The use of such mediaand agents for pharmaceutically active substances is well known in theart. Except insofar as any conventional media or agent is incompatiblewith the therapeutic compound, use thereof in the compositions suitablefor pharmaceutical administration is contemplated. Supplementary activecompounds can also be incorporated into the compositions.

Carrier or substituent moieties useful in the present invention may alsoinclude moieties which allow a therapeutic compound to be selectivelydelivered to a target organ. For example, delivery of a therapeuticcompound to the brain may be enhanced by a carrier moiety using eitheractive or passive transport (a “targeting moiety”). Illustratively, thecarrier molecule may be a redox moiety, as described in, for example,U.S. Pat. Nos. 4,540,654 and 5,389,623, both to Bodor. These patentsdisclose drugs linked to dihydropyridine moieties which can enter thebrain, where they are oxidized to a charged pyridinium species which istrapped in the brain. Thus drugs accumulate in 45 the brain. Othercarrier moieties include compounds, such as amino acids or thyroxine,which can be passively or actively transported in vivo. Such a carriermoiety can be metabolically removed in vivo, or can remain intact aspart of an active compound. Structural mimics of amino acids (and otheractively transported moieties) including peptidomimetics, are alsouseful in the invention. As used herein, the term “peptidomimetic” isintended to include peptide analogs which serve as appropriatesubstitutes for peptides in interactions with e.g., receptors andenzymes. The peptidomimetic must possess not only affinity, but alsoefficacy and substrate function. That is, a peptidomimetic exhibitsfunctions of a peptide, without restriction of structure to amino acidconstituents. Peptidomimetics, methods for their preparation and use aredescribed in Morgan et al., (1989) “Approaches to the discovery ofnon-peptide ligands for peptide receptors and peptidases”. In Annualsorts in Medicinal Chemistg (Vinick, FJ., ed.) pp. 243-252, AcademicPress, San Diego, Calif. Many targeting moieties are known, and include,for example, asialoglycoproteins (see e.g., Wu, U.S. Pat. No. 5,166,320)and other ligands which are transported into cells via receptor-mediatedendocytosis (see below for further examples of targeting moieties whichmay be covalendy or non-covalently bound to a target molecule).

In the methods of the invention, pain and/or inflammation in a subjectis mitigated by administering an analgesic, sedative oranti-inflammatory therapeutic compound of the invention to the subject.The term “subject” is intended to include living organisms in which paincan occur. Examples of subjects include humans, apes, monkeys, cows,sheep, goats, dogs, cats, mice, rats, and transgenic species thereof.Administration of the compositions of the present invention to a subjectto be treated can be carried out using known procedures, at dosages andfor periods of time effective to alleviate pain in the subject. Aneffective amount of the therapeutic compound necessary to achieve atherapeutic effect may vary according to factors such as the subject,the age, sex, and weight of the subject, and the ability of thetherapeutic compound to mitigate pain and inflammation in the subject.Dosage regimens can be adjusted to provide the optimum therapeuticresponse. For example, several divided doses may be administered dailyor the dose may be proportionally reduced as indicated by the exigenciesof the therapeutic situation. A non-limiting example of an effectivedose range for a therapeutic compound of the invention (e.g., Va) isbetween 0.5 and 5000 mg/kg of body weight/per day, preferably between 50and 1000 mg/kg/day, and still more preferably between 250 and 750mg/kg/day. In an aqueous composition, preferred concentrations for theactive compound (i.e., the therapeutic compound that can mitigate pain)are 46 between 5 and 500 mM, more preferably between 10 and 100 mM, andstill more preferably between 20 and 50 mM.

According to the invention, therapeutic compounds are administered to asubject by a route which is effective for mitigating inflammation,effecting analgesia and/or effecting sedation. Suitable routes ofadministration include but are not limited to sublingual, oral, buccal,transdermal, nasal, subcutaneous, intraocular, intravenous,intramuscular and intraperitoneal (e.g., by injection). Preferred routesof administration are oral and transdermal. The therapeutic compoundscan be administered with a pharmaceutically acceptable vehicle.Depending on the route of administration, the active compound may becoated in a material to protect the compound from the action of acids,enzymes and other natural conditions which may inactivate the compound.

Therapeutic compounds of the invention can be formulated to ensureproper distribution in tivo. For example, the blood-brain barrier (BBB)excludes many highly hydrophilic compounds. To ensure that thetherapeutic compounds of the invention cross the BBB, they can beformulated, for example, in liposomes. For methods of manufacturingliposomes, see, e.g., U.S. Patents 4,522,811; 5,374,548; and 5,399,331.The liposomes may comprise one or more moieties which are selectivelytransported into specific cells or organs (“targeting moieties”), thusproviding targeted drug delivery (see, e.g., Ranade et al., 1989).Exemplary targeting moieties include folate or biotin (see, e.g., U.S.Patent 5,416,016 to Low et al.); mannosides (Umezawa et al., 1988);antibodies (Bloeman et al., 1995; Owais et al., 1995); surfactantprotein A receptor (Briscoe et al., 1995). In a preferred embodiment,therapeutic compounds of the invention are formulated in liposomes; in amore preferred embodiment, the liposomes include a targeting moiety.

Delivery and in tvito distribution can also be affected by alteration ofan anionic group of compounds of the invention. For example, anionicgroups such as phosphonate or carboxylate can be esterified to providecompounds with desirable pharmocokinetic, pharmacodynamic,biodistributive, or other properties. Exemplary compounds include Mi andpharmaceutically acceptable salts or esters thereof To administer atherapeutic compound by other than parenteral administration, it may benecessary to coat the compound with, or co-administer the compound with,a material to prevent its inactivation. For example, a therapeuticcompound may be administered to a subject in an appropriate carrier, forexample, liposomes, or a diluent. Pharmaceutically acceptable diluentsinclude saline and aqueous buffer solutions. Liposomes includewater-in-oil-in-water CGF emulsions as well as conventional liposomes(Strejan et al, J. Neuroimmunol. (1984) 7, 27). 47

A therapeutic compound may also be administered parenterally (e.g.,intramuscularly, intravenously, intraperitoneally, intraspinally, orintracerebrally). Dispersions can be prepared in glycerol, liquidpolyethylene glycols, lactose, dextrose and mixtures thereof and inoils. Under ordinary conditions of storage and use, these preparationsmay contain a preservative to prevent the growth of microorganisms.Pharmaceutical compositions suitable for injectable use include sterileaqueous solutions (where water soluble) or dispersions and sterilepowders for the extemporaneous preparation of sterile injectablesolutions or dispersion. In all cases, the composition must be sterileand must be fluid to the extent that easy syringability exists. It mustbe stable under the conditions of manufacture and storage and must bepreserved against the contaminating action of microorganisms such asbacteria and fungi. The vehicle can be a solvent or dispersion mediumcontaining, for example, water, ethanol, polyol (for example, glycerol,propylene glycol, dextrose, and liquid polyethylene glycol, and thelike), suitable mixtures thereof, and vegetable oils. The properfluidity can be maintained, for example, by the use of a coating such aslecithin, by the maintenance of the required particle size in the caseof dispersion and by the use of surfactants.

Prevention of the action of microorganisms can be achieved by variousantibacterial and antifungal agents, for example, parabens,chlorobutanol, phenol, ascorbic acid, thimerosal, and the like. In somecases, it will be preferable to include isotonic agents, for example,sugars, sodium chloride, or polyalcohols such as mannitol and sorbitol,in the composition. Prolonged absorption of the injectable compositionscan be brought about by including in the composition an agent whichdelays absorption, for example, aluminum monostearate or gelatin.

Sterile injectable solutions can be prepared by incorporating atherapeutic compound in the required amount in an appropriate solventwith one or a combination of ingredients enumerated above, as required,followed by filter sterilization. Generally, dispersions are prepared byincorporating the therapeutic compound into a sterile vehicle whichcontains a basic dispersion medium and the required other ingredientsfrom those enumerated above. In the case of sterile powders for thepreparation of sterile injectable solutions, the preferred methods ofpreparation are vacuum drying and freeze-drying which yields a powder ofthe active ingredient (i.e., the therapeutic compound) plus anyadditional desired ingredient from a previously sterile-filteredsolution thereof.

A therapeutic compound can be orally administered, for example, with aninert diluent or an assimilable edible carrier. A therapeutic compoundand other ingredients may also be enclosed in a hard or soft shellgelatin capsule, compressed into tablets, or incorporated directly intothe subject's diet. For oral therapeutic administration, a therapeuticcompound may be incorporated with 48 excipients and used in the form ofingestible tablets, buccal tablets, troches, capsules, elixirs,suspensions, syrups, wafers, and the like. The percentage of therapeuticcompound in the compositions and preparations may, of course, be varied.The amount of therapeutic compound in such therapeutically usefulcompositions is such that a suitable dosage will be obtained.

It is especially advantageous to formulate parenteral compositions indosage unit form for ease of administration and uniformity of dosage.Dosage unit form as used herein refers to physically discrete unitssuited as unitary dosages for the subjects to be treated; each unitcontaining a predetermined quantity of therapeutic compound calculatedto produce the desired therapeutic effect in association with therequired pharmaceutical vehicle. The specification for the dosage unitforms of the invention are dictated by and directly dependent on (a) theunique characteristics of the therapeutic compound and the particulartherapeutic effect to be achieved, and (b) the limitations inherent inthe art of compounding such a therapeutic compound for the treatment ofpain and inflammation in subjects, or effecting sedation.

A therapeutic composition can be administered in time-release or depotform, to obtain sustained release of a therapeutic compound over time. Atherapeutic compound of the invention can also be administeredtransdermally (e.g., by providing a therapeutic compound, with asuitable carrier, in patch form, or in an unguent or cream).

Active compounds are administered at a therapeutically effective dosagesufficient to mitigate pain and/or inflammation in a subject. Theability of a compound to mitigate pain or inflammation can be evaluatedin model systems that may be predictive of analgesia andanti-inflammation in human diseases, such as animal model systems knownin the art (including, e.g., the preclinical acute pain writhing modelin the mouse; and the formalin-sensitization model of tissue injury painin the rat) or by in mitro methods, (including, e.g., the assaysdescribed above and below, tide infra). The ability of a compound toeffect sedation can be evaluated in model systems that may be predictiveof sedation of use in treatment of human diseases, such as animal modelsystems known in the art (including, e.g., the loss of the rightingreflex in the mouse as described, tide infra) or by in vitro methods,(including, e.g., modulation of the activity of GABAA receptors asdescribed above and below, tide infra).

It will be appreciated that the ability of a compound of the inventionto mitigate pain and/or inflammation, in certain embodiments, beevaluated by observation of one or more symptoms or signs associatedwith pain and inflammation in vivo. Thus, for example, the ability of acompound to alleviate pain may be associated with an observableimprovement in a clinical manifestation of the 49 underlying pain orinflammation related disease state or condition, or a slowing or delayin progression of symptoms of the condition. Thus, monitoring ofclinical manifestations of disease can be usefuil in evaluating theanalgesic, sedative and anti-inflammatory efficacy of a compound of theinvention.

Treating or mitigating pain may involve effecting analgesia, effectingsedation, inhibiting or preventing inflammation, and/or ameliorating themanifestations or impact of pain inducing stimuli. Modulating abiological process such as the biological levels of cGMP or cAMP, oractivity of soluble GCase, includes regulating increases and decreasesin such activity, and inhibition, potentiation, agomism, or antagonismof the biological process.

Methods of the invention are useful for treating pain and/orinflammation associated with any disease in which pain or inflammationoccurs. Clinically, pain and inflammation can be associated with, butnot limited to, tissue injury, post-operative tissue injury, nerveinjury, post-herpetic neuralgia, phantom limb pain, diabetic neuropathy,arthritis, dysmenorthea, endometriosis, cancer, chemotherapy, myocardialinfarction, cerebral vascular occlusion, or result from surgicalprocedures.

Certain compounds for use in the methods of the invention arecommercially available, whereas others are novel (see hereinbelow andapplicants' co-pending application U.S. Ser. No. 09/267,379, filed Mar.15, 1999, now U.S. Pat. No. 6,310,052). Both types can be synthesized bystandard techniques known in the art. In general, nitrate esters can beprepared from the corresponding alcohol, oxirane or alkene by standardmethods that include: nitration of alcohols and oxiranes, mixedaqueous/organic solvents using mixtures of nitric and sulfuric acidand/or their salts, with temperature control (see Yang et al., 1996);nitration of alcohols and oxiranes in acetic anhydride using nitric acidor its salts with or without added acid catalyst, with temperaturecontrol (see, e.g., Louw, et al., 1976); nitration of an alcohol with anitronium salt, e.g., a tetrafluoroborate; nitration of an alkene withthallium nitrate in an appropriate solvent (Ouellette et al., 1976).Compounds of the present invention also can be prepared as describedbelow.

The contents of all scientific publications and patent documents citedherein are hereby incorporated herein by reference in their entirety.

The following Examples further illustrate the present invention and arenot intended to be limiting in any respect.

EXAMPLES Example 1

Characterization of Guanylyl Cyclase Activation

Activation of soluble guanylyl cyclase (GCase) by nitrates IIIm, IVa,IVb, WVd, IVe, WVf, Ig, WVj, Va, Vb, and GTN was assayed employingpartially purified enzyme freshly prepared from the 105,000 gsupernatant fraction of rat aorta homogenates, using theradioimmunoassay method described by Bennett et al. (1992).Dose-response curves were obtained for GCase activation by nitrates IVa,IVb, IVd, IVe, IVf, IVg, IVj, and GTN in the presence and absence ofcysteine and dithiothreitol (DTT; both 2mM). In all cases, data werenormalized to the maximal GTN response carried out in identical GCasepreparations. Experimental incubations were performed at 37° C for 10min. The data for WVd is summarized in FIG. 1. The GCase assay data showthat WVd activates GCase, with a submiulimolar EC-50 (effectiveconcentration for 50% of the subjects) in the absence of any addedthiol, in contrast to GTN, which requires added cysteine. Compounds WVdalso activates GCase in the presence of DTT, in contrast to GTN, which,emgmatically, does not. Relative to GTN itself, a wide range of potencywas observed for these novel nitrate esters. No activation of GCase byglycerol mononitrates was observed in this assay at the concentrationsof nitrate employed.

Activation of GCase, in titrv, by some of these organic nitrates is viarelease of NO, since in the presence of cysteine, substantial NO isreleased at rates which are measurable amperometrically, using themethod described by Artz and Thatcher (1998). By comparison,nitroglycerin, which is currently understood by others skilled in theart to act only as an NO-donor therapeutic agent, does not release NO ata rate measurable amperometrically, in the absence nor the presence ofcysteine. Relative rates for NO release, at 37° C, pH 7.4, in thepresence of cysteine (2mM) from nitrates Vj, Vu, Vi, Vh, Vg, Vf, and Ve,(lmM) were 1.0, 1.0, 1.8, 0, 1.2, 0.5, 1.8, respectively. Thusmodification of the structure of these organic nitrates can be used tocontrol their NO-releasing ability and also to modulate GCase activity.

To test for potential differences in GCase activation by nitrates, theeffects of IlIm, IVh, Va, Vb, and GTN were assayed in brain and vasculartissue. WI) had no effect on GCase activity in either rat aorta or rathippocampus (FIG. 2). IIm had greater efficacy to stimulate GCaseactivity compared to GTN in both rat aorta and rat hippocampus (FIG. 2).Vb was found to be equivalent to GTN in efficacy and potency foractivation of GCase in both rat aorta and rat hippocampus (FIG. 3). Vawas found to have greater efficacy, but equal potency, to GTN in rataorta (FIG. 3a). In contrast, Va had greater efficacy and greaterpotency to stimulate GCase in rat hippocampus (FIG. 3b). These dataillustrate that nitrates have differential effects on GCase activationthat are dependent on both structure of the compound and the tissueassayed for GCase activity, supporting the notion that effects ofnitrates elicited through GCase activation, such as analgesia andvasodilation, are separable and may be regulated in a tissue-specificand/or activity-specific manner, by appropriate choice of organicnitrate.

As further examples of the potential for modulating potency, efficacyand tissue selectivity for activation of GCase, by choice of anappropriate organic nitrate, nitrates Vaa and Vt were assayed in brainand vascular tissue. In the presence (+) and absence (-) of lmMcysteine, the potency (EC-50 values) and efficacy (maximal activation)were measured for activation of GCase from rat hippocampus (Table 2).TABLE 2 maximal (hipp.), maximal (aorta), 1 mM cysteine EC-50 (hipp.), MEC-50 (aorta), M relative to GTN^(a) relative to GTN^(a) Vaa + 1.4 ×10⁻⁴ 1.8 × 10⁻⁴ 5.1 2.2 Vaa − 5.7 × 10⁻⁵ 1.8 × 10⁻⁴ 2.1 1.0 Vt + 5.1 ×10⁻⁵ 6.5 × 10⁻⁵ 3.0 2.3 Vt − 1.7 × 10⁻⁵ 1.8 × 10⁻⁶ 1.8 1.7^(a)Normalized to GTN + 1 mM cysteine maximal response.

Example 2

Characterization of Cyclic GMP Accumulation

In order to extend the GCase data further, the effects of nitrates Va,IlIm, Vb, Vc, and WVk on cyclic GMP accumulation in intact isolated rataorta were examined (FIGS. 4, 5). Thoracic aortic strips were preparedfrom male Sprague-Dawley rats (Charles-River, Canada) as described inMcGuire et al. (1994) and Stewart et al. (1989). Tissues were contractedsubmaximally with phenylephrine (0.1CtM) and exposed to variousconcentrations of drug for 1 min. Cyclic GMP accumulation was determinedusing the radioitnmunoassay method described by Bennett et al. (1992).At concentrations of 1 liM and 10 AM, GTN and WVk significantlyincreased cGMP accumulation (FIGS. 5). At a concentration of 1 AM, Va,IIlm, Vb, and Vc did not significantly increase cyclic GMP accumulation(FIGS. 4a, 5a). At a concentration of 10 [tM, Va, Vb, and WVksignificantly increased cyclic GMP accumulation whereas IIIm and Vc didnot (FIGS. 4b, 5b).

Sections of rat hippocampus (400 lim) were prepared and incubated inoxygenated Krebs solution at 37° C. After a 60-min equilibration period,the brain slices were stimulated with different concentrations of Va orGTN for 3-trin. Cyclic GMP accumulation was determined as describedabove for aortic strips. FIG. 6 shows that Va causes aconcentration-dependent increase in the tissue levels of cGMP in rathippocampal brain slices in vitro, and that at high concentration (100lM) Va is more effective than GTN in elevating cGMP levels inhippocampal brain slices in vitm. These data are in very good agreementwith the differential effects of Va and GTN on hippocampal GCaseactivity shown in FIG. 3 b.

Example 3

Characterization of Relaxation of Isolated Blood Vessels

In order to extend the GCase data, the relaxing effects of nitratesIllm, WVc, WVd, WVf, WVg, WVh, Wk, Va, Vb, and Vc on rat aortic tissuewere examined. Thoracic aortic strips were prepared from maleSprague-Dawley rats (Charles-River, Canada) as described in McGuire etal. (1994), and Stewart et al. (1989). Tissues were contractedsubmaximally with phenylephrine (0.1 pM) and exposed to variousconcentrations of nitrovasodilator to obtain concentration-responsecurves. In this intact tissue assay, all of the nitrates were observedto cause relaxation of the tissue with a maximal relaxant response equalto that obtained with GTN. However, the compounds differed in potency,with EC-50 values of 7.87 nM, 94.3 nM, 6.59 ,M, 25.2 tM, 11.0 μM, and0.203 μM, for GTN and compounds Va, IVd, IVg, WVf, and IVc, respectively(FIG. 7,8). In another series of experiments, the EC-50 values forrelaxation were 0.61 nM, 3.19 nM, 8.40 nM, 0.153 μM, 0.437 μM and 6.89lM for GTN, WVk, Vb, IIIm, Vc, and IVh, respectively (FIG. 7,8).Compounds WVd and WVc were tested for their ability to cause vascularrelaxation in tissues that had been made tolerant to the relaxant effectof GTN. GTN tolerance was induced by incubating tissues with highconcentrations of GTN (0.5 mM GTN for 30 min). Under these conditions,the maximal relaxant effects of WVd (FIG. 12 a) and WVc (FIG. 12 b) werenot significantly different to that of untreated tissue. The EC-50 forrelaxation was imcreased approximately threefold, but the difference wasnot statistically significant.

Example 4

Characterization of Blood Pressure Changes in the Whole Animal

To test for differential effects of nitrates on blood pressureresponses, Va and GTN were injected into rats in which the abdominalaorta was cannulated for blood pressure recording. In the firstexperiment, Va and GTN were injected subcutaneously at a dose of 400lmol/kg body weight into conscious, freely moving animals. GTN caused asmall and transient decrease in blood pressure in these animals, whereasVa had no discernable effect on arterial blood pressure (FIG. 9). Va andGTN were subsequently tested in anesthetized rats in which the abdominalvena cava was also cannulated to allow for bolus intravenous injectionof drugs. In this preparation, GTN caused a substantial anddose-dependent decrease in arterial blood pressure. In contrast, Va atequal doses had very modest effects on blood pressure at doses lowerthan 2 lmol/kg body weight (FIG. 10). These data are in very goodagreement with the results obtained for these two agents using theisolated blood vessel preparation.

The plasma levels of nitrates Vb and Vc (the denitrated metabolite ofVb) were measured to gain insight into the handling of these moleculesin the body. Cannulas were placed in the abdominal aorta for bloodsampling. After a two-day recovery period, a single subcutaneous dose ofVb (200 lmol/kg) was administered and blood samples collected over aperiod of six hours. Samples were centrifuged, the plasma collected, andthe concentration of Vb and Vc determined by gas-liquid chromatographyby the method of McDonald and Bennett (1990). The data obtained for Vband Vc indicate that nitrates achieve maximal plasma levels within 30minutes after subcutaneous injection, and therafter decline at a steadyrate (FIG. 11). These data suggest that nitrates have excellentbioavailability after subcutaneous injection.

Example 5

Characterization of the Analgesic Effects of Novel Organic Nitrates in aModel of Acute Pain

Injection of dilute acetic solutions into the peritoneum of a mouseinduces writhing movements that can be quantified. We adopted themethodology described by Bak et al. (1998) to test for analgesic effectsof organic nitrates in this mouse model. Each mouse was given anintraperitoneal injection of 0.5 mL of a 0.6% solution of acetic acid indistilled water. After a 5 minute delay, the number of writhingmovements was counted over a 10 minute period. To test the efficacy ofnovel organic nitrates in this model, drugs were administered at dosesof 100-500 mg/kg given by subcutaneous injection) 15 minutes before theintraperitoneal injection of acetic acid. In this model of acute pain,Vm induced a significant, dose-dependent analgesic effect, manifested asa decrease in the number of writhes per 10 minute period afterintraperitoneal injection of dilute acetic acid (FIG. 13 a). Va was alsoable to act as an analgesic (decreased writhing) in this experimentalmodel when administered at a dose of 500 mg/kg subcutaneously (FIG.13b).

Example 6

Characterization of the Analgesic Effects of Novel Organic Nitrates in amodel of Hyperalgesia/Allodymia

Under light halothane anesthesia, male Sprague-Dawley rats were injectedsubcutaneously with 0.05 mL of 5% formnalin into the dorsal surface ofone hind paw as described in Malmberg and Yaksh (Anesthesiology (1993)79, 270-281). The number of spontaneous paw flinches was determined in 1minute blocks at 5 minute intervals for 60 minutes. Fortnalin injectionin the paw produces two distinct phases of pain; an acute phaseoccurring within the first 5-10 minutes, and a delayed phase thatdevelops between 15-30 minutes after formalin injection. The acute phaseof the pain response to formalin is caused by activation of peripheralnociceptive sensory afferents (C-fibres) by the peripheral stimulus. Thedelayed pain response is considered to be a hyperalgesia/allodyniacaused by a combination of sensitization of peripheral sensory afferentsand sensitization of synaptic connections in the spinal cord. Theformalin test in the rat is considered to be an appropriate model fortissue injury pain occurring in humans (Tjolsen et al., Pain (1992) 51,5-17; Yaksh, 77PS (1999) 20, 329-337). In this experimental model ofinflammatory tissue injury pain, Vm (500 mg/kg) significantly reducedboth phases of the pain response to formalin injection (FIG. 14a,b).

Example 7

Synthesis of IIIe

To acetic anhydride (3 iL) was added gradually, with strring, 70% nitricacid (0.26 mL), while keeping the temperature between 20-300 by externalcooling. With continuous vigorous stiring the mixture was cooled to-30-350 and 2′,3′-dideoxy-3-thiocytosine (0.25 g) was added. After 10nrn at -35o, the reaction mixture was heated up to -200 and then stirredat -20-100 for 15 min and 10 min at 00. The resulting reaction mixturewas poured into ice-water, stirred for 1 h, then NaHCO₃ was added byportions until CO₂ evolution ceased. The water solution was extractedwith 3×20 mL of ethyl acetate. Combined extracts were dried (MgSO4) andconcentrated. 0.38 g of slightly yellowish oil was obtained. The oilcrystallized in a day and was recrystallized from CHCl₃. Yield 52%.Conversion to the nitrate was evidenced by the significant downfieldshift of the C5′ proton multiplet from 6 3.6 to 4.85 ppm.

Example 8

Synthesis of Nitrate IIIf

0.26 mL (4.15 rumol) conc. HNO₃ was added to 2 mL acetic anhydride suchthat the temperature did not exceed 25-30° C. The mixture was cooled at0-5° C. and 0.3 g (1.88 mmol) of 5-(1,²-dihydroxyethyl)-4-methylthiazolewas added in several portions, the temperature being kept below 5 OC.The reaction mixture was stirred at 0-5° C. for 45 min and then 0.45 mLwater was added. The mixture was stirred for 30 rnin and then rotavaryevaporated. The residue was neutralized by adding 5 mL of saturatedNaHCO₃ solution and the organic product was extracted with ethylacetate. The organic layer was concentrated and the dinitrate Illf waspurified through column chromatography (silica gel/ethyl acetateeluant). A slightly yellow solid was obtained. Yield: 0.150 g (32%).

Example 9

Synthesis of Nitrate IIIi

Nitrate IIIi was obtained by two routes. Route I proceeded from theelimination reaction of IIIm in basic solution. Route II proceeded fromnitration of trans-3-bromo-4-hydroxytetrahydrothiophene-1,1-dioxide,yielding nitrate Illn, followed by reaction with a weak base, e.g.,sodium thiocyanate in 2-butanone. Purification may be achieved withsilica flash column chromatography using 1:1 hexane:ethyl acetate aseluant.

Example 10

Synthesis of Nitrate HIIj 1,4-Dibromo-2,3-butanediol may be nitrated:(a) using a nitration mixture prepared from HNO₃ and H₂SO₄ over 2 days;or (b) using acetyl nitrate reacting for 2 hours. Work-up requiresquenching of the reaction mixture in ice-water for an hour, extraction,drying, and evaporation. Successful purification of the title compoundby silica gel column chromatography is achieved on a 25 g scale using amixture of 70% hexane and 30% CH₂CI₂ as eluent.

Example 11

Synthesis of Nitrate Ve

4-Methylbenzenethiol was obtained by adaptation of literature proceduresfrom p-toluidine (.-P. Morizur, Bull Soc. Chim. Fr. (1964) 1338-1342;Bourgeois, Recl. Trav. Chim. Pays-Bas (1899) 18, 445-450). p-Toluidinehydrochloride (14.2 g, 0.098 mole) was diazotised at 5OC withconcentrated hydrocloric acid (16.5 mL) and sodium nitrite (7.2 g, 0.104mole) in water (12 mL). The solution of diazonium salt was added over1.5 h to a solution of ethyl xanthate (24 g, 0.149 mole) in water (30niL) at 45-500C. The mixture was kept at this temperature, understrring, for a further 1 h. The xanthate ester was separated as a maroonoil, washed with 50 mL 10% NaOH and with water to neutral pH and driedover MgSO₄ (²⁰g of crude product). The crude xanthate was dissolved in60 mL absolute ethanol and to this solution 20 g KOH (pellets) wereadded in portions. The reaction mixture was refluxed under stiring andAr for 8 h, then concentrated under vacuum. The concentrate was taken upin 50 niL H₂0 and extracted with 3x100 mL diethyl ether. The aqueouslayer was acidified with a 6N H2SO4 solution and extracted with 3x100 mLCH₂Cl₂. The combined extracts were washed with water, dried over MgSO₄,evaporated and flash columned on silica gel, eluant hexanes:ethylacetate=9:1, giving 10 g (81.56%/0) of 4-methylbenzenethiol.¹H-NMR(CDCl₃, 300 MHz):7.18-7.24 (m, arom 2H), 7.04-7.11 (d, arom 2H,J7.93), 3.41(s, 1 H), 2.32(s, 3H). 13C-NMR(75.48 MHz): 21.34, 128.95,130.24,130.29,136.05.

The dinitrate WVd (9.67 mmoles) was dissolved in 10 niL distilled waterand the solution kept under Ar for 30 minutes. To this solution, asolution of 0.8 g (6.46 rnnoles) of 4-methylbenzenethiol and 7 nL 1MNaOH was added dropwise. The resulting emulsion was stirred for 15 minand then extracted with 3×20 mL CH₂Cl₂. The combined organic extractswere washed with H₂O, dried over MgSO₄ and concentrated under vacuum.The remaining oil was purified by flash column chromatography on silicagel, eluant hexanes: ethyl acetate=9:1, giving the product Ve (1.097 g,52.22%). ¹H-NMR(CDCl₃, 300 MHz):7.44-7.51 (m, atom 2H), 7.17-7.24 (d,atom 2H,J 7.91), 5.47-5.59 (m, 1H), 4.83-4.93 (dd, 1H,J 12.81, 2.78),4.57-4.67 (dd, 1H,J 12.82, 5.71), 3.02-3.12 (dd, 1H,J 14.48, 6.01),2.9-2.99 (dd, 1H,J 14.47, 7.72), 2.38 (s, 3H). ¹³C-NMR(75.48 MHz):21.53, 36.78, 69.82, 77.68, 130.52, 130.62, 132.55, 139.23.

Example 12

Synthesis of Nitrate IIIm 3,4-Epoxytetrahydrothiophene-1,1-dioxide (250mg,1.9 nmnol) was refluxed for 24 h in 10 miL of water and 25mg oftoluenesulfonic acid. After the first 6 h, another 25 mg of the acid wasadded. The reaction was monitored by thin layer chromatography (LLC) (5%methanol in dichloromethane). Purification was by Si flash columnchromatography using 5% methanol/CH2Ck2 as eluent to afford 200 mg ofdiol. The diol was nitrated in a cooled solution of conc. sulfuric acid(2 mol eq.), nitric acid (70%, 2 mol eq.) in an ice bath. Thetemperature was maintained as close to O° C as possible. The ice bathwas removed and the mixture was allowed to stir for 1 hour (reaction wasmonitored by TLC, 100% CH₂Cl₂ eluent). The acid layer was removed andthe organic layer washed with: (i) water; (ii) 10% sodium carbonate;(iii) 100% urea; (iv) water. Drying over sodium sulfate, filtration andconcentration, yielded crude product which was purified by flash columnchromatography, with dichloromethane as eluent. An alternative routeinvolves direct nitration of 3,4-epoxytetrahydrothiophene-1,1-dioxide ina similar nitration mixture.

Example 13

Synthesis of Nitrate IVk

1.17 niL (18.2 nmuol) concentrated HNO₃ was added, under stirring andcooling (0-5 OC), to 1 mL (18.2 mmol) concentrated H₂SO₄ and then 2 g(14 mmol) of 4-methyl-5-(2-hydroxyethyl)thiazole was added dropwise intothe nitration mixture, the temperature being kept under 10 OC. Themixture was stirred for 3 hours at room temperature, diluted with 10 niLof water and neutralized with solid NaHCO₃. The organic product wasextracted with ethyl acetate and purified by column chromatography(silica gel/ ethyl acetate eluant) to produce a colorless oily product.Yield: 1.18 g (45%).

Example 14

Synthesis of Nitrate IVi

0.03 g (0.035 niL) of allyl cyanide was added to a stirred suspension of0.22 g (0.5 mmol) of Tl (NO₃)₃.3H₂O in 2 mL of pentane. After 20 min ofvigorous stirring the pentane solution was decanted and evaporated todryness. After evaporation the residual oil (0.44 g) was columned(CH₂Cl₂, Rf 0.64 (CH₂Cl₂). Clean oil rmmediately crystalized duringattempt to dissolve it in CDCl₃. Yield 0.065 g (76%). The structure ofIVn was confirmed by X-ray analysis. IR (film): 1297.03, 1678.91,2258.91 (CN). Mass spec. m/z (CI+, fragment, %): 191.9 (M+H, 2.44),129.0 (16.41), 81.9 (100). Calculated for C₄H₅N₃0₆ 191.02.

Example 15

Synthesis of Nitrate IVm

0.9 g (0.75 nL, 4.92 mmol) of allyphenyl sulfone was added dropwise to astirred suspension of 2.43 g (5.47 mmol) of T1 (NO3)3.3H20 in 10 mL ofpentane. The resulting mixture was stirred overnight. The pentanesolution was decanted. 2x10 mL of methanol were added to the reactionmixture, stirred for 10 minutes and extracts were added to the pentanesolution. The combined extracts evaporated to dryness and purified bysilica flash column chromatography using CH₂CI₂ as eluant. Yield 0.08 g(15%). IR (KBr): 1152.39, 1290.91, 1273.12, 1353.83, 1646.08. Mass spec.m/z (CI+fragment, %): 307.0 (M+1, 66.5), 244.0 (100%). Calculated forCgHloN₂0₈S 306.02.

Example 16

Synthesis of Nitrate Va

2.2 g (7.3 nmmol) of nitrate IVd was dissolved in 5 g of cold H₂0₂ (30%,0° C) and then 1 g of 10% H₂SO₄ was added. The mixture was stirred at0-5 ° C. until a white oil separated (ca. 30-60 min). The aqueous layerwas discarded and the oil was dissolved in dichloromethane, washedsuccessively with water, then NaHCO₃ solution and finally water. Theorganic solution was dried over MgSO₄. Removal of the solvent produced1.3 g of the crude product which was purified by column chromatography(Silicagel, CH₂Cl₂/hexanes: 70/30). Yield: 0.650 g (45%).

Example 17

Synthesis of Nitrate Vc

3 g (8.88 nimol) of 1,4-dibromo-2,3-dinitrobutanediol and 2.81 g (18inmol) of Na₂S₂O₃.5H₂O were dissolved in the mixture of 100 niL ofmethanol and 45 mL of H₂O. The resulting solution was heated during 4days at 40-45°. After this time the reaction mixture was partiallyevaporated to reduce the volume of solvents. The resulting mixture wasextracted 4x50 niL of ethyl ether. The extracts were combined, washed(H20), dried (MgSO4) and evaporated to minimum. Column chromatographyafforded the title compound in 10% yield, seperated from Vb the majorproduct.

Example 18

Synthesis of Nitrate Vy

The title compound was synthesised by the reaction of rVd with4-methyl-5-thiazole ethanthiol, in a similar procedure to that used inExample 11. The crude product was purified by column chromatography(Silicagel, ethyl acetate eluant) to give product (50 mg, 27.32%).¹H-NMR(CDCl₃, 300 MHz): 8.22 (s, 1H), 5.49-5.6 (m, 1H), 4.9-5.00(dd,1H), 4.64-4.78 (dd, 1H), 3.14-3.22 (t, 2H), 2.89-3.07 (m, 4F), 2.45(s, 3F). Mass spec., m/z (EI+, fragment, %): 355.0 .Calculated forC₉H₁₃N₃O₆S₃: 355.0. The 4-Methyl-5-tdliazole precursor was obtained from4-methyl-5-thiazole ethanol, thiourea and hydrobromic acid by adaptationof literature procedures (R.L. Frank, P. V. Smith, J. Am. Chem. Soc.(1946) 68, 2103-2104). A mixture of 2 g 4-methyl-5-thiazole ethanol(13.965 mmoles), 1.063 g(¹³.⁹⁶⁵ mmoles) thiourea and 9.45 g (56 nimoles)hydrogen bromide as 48 % hydrobromic acid was refluxed for 7 h withstirring, under Ar. A solution of 2.24 g (56 mmoles) of NaOH in 20 mL ofwater was then added and the mixture was refluxed without stirring for 2h. The layers were separated, and the acidified aqueous layer wasextracted with three 30 mL portions of CH₂Cl₂. The extracts and originalorganic layer were combined, dried over MgSO4 and concentrated undervacuum to afford 1.9 g crude product which was purified by columnchromatography using ethyl acetate as eluent (Yield 1.6 g, 75%).¹H-NMR(CDCl₃, 300MHz): 8.5 (s, 1H), 2.94-3.02 (t, 2H),2.62-2.72 (q, 2H),2.33 (s, 3H), 1.38-1.45 (t, 1H). ¹³C-NMR(75.48 MHz): 15.41, 26.41,31.51, 39.72, 129.36, 149.90

Example 19

Synthesis of Nitrate IIIk and IIIl

Synthesis from dinitrate IIIj proceeded by refluxing with sodium otpotassium thiocyanate (2 eq.) in 2-butanone for 8 h. After cooling, aprecipitate was removed by filtration and the filtrate was concentrated.Nitrates li1k and IIIl were separated by silica flash columnchromatography with hexane/dichloromethane as eluent.

Example 20

Synthesis of Nitrate Vk.

IVd ( 0.43 g, 1.37 mmol) was dissolved in 10 mL of distilled water andthe emulsion of 0.23 g (1.28 mmol) of the ethyl ester of thiosalycilicacid in 1.3 niL of 1 M NaOH was added. The resulting solutionimmediately became turbid and was stirred for 3 min, then extracted withethyl acetate (4x15 iL). The resulting extracts were washed with H₂O,dried (MgSO4), and concentrated by evaporation. The residue was flashcolumned on silica gel, eluant hexane:ethyl acetate=9:1 Rf 0.23), giving0.27 g (55%) of Vk. ¹H-NMR(CDCl₃, 300 MHz): 8.06-8.12 (1H, dd,J 8.12,0.36), 7.99-8.04 (IH, dd,J 7.8, 1.15), 7.51-7.59 (1H, m,J 7.24, 1.44),7.21-7.29 (IH, m,J 7.35, 0.54), 5.40-5.49 (1H, m), 4.70-4.78 (1H, dd,J13.04, 2.95), 4.33-4.45 (3H, m, superposition of dd a 13.08, 6.01) of11H from CH₂-ON0₂ and quart. from O-CI,-CH₃), 2.66-2.87 (2H, m),2.06-2.15 (2H, quart.,J 6.92), 1.35-1.43 (3H, t,J 7.14). ¹³C-NMR:(CDCl₃, 75.48 MHz): 166.21, 140.41, 132.78, 131.46, 127.63, 125.48,77.25, 71.03, 61.42, 32.51, 28.29, 14.17. Mass spec. m/z (EI+, fragment,%): 392.3 (M+, 3.69), 153 (100). Calculated for C₁₃Hl₆N₂0₈S₂392.03 .

Example 21

Chiral Synthesis of Nitrate IVd

A 50 mnL round-bottom flask, equipped with a magnetic stirrer, wascharged with 10 niL of tert-butyl alcohol, 10 m]L of water, and 2.8 g ofa catalyst (AD-mix-B, Aldrich: K.B.Sharpless, W.Amberg, Y.L.Bennani,G.A.Crispino, J.Hartung, K.-S.Jeong, H.-L.Kwong, K.Morikawa, Z.-M.Wang,D.Xu, X.-L.Zhang,J.Otg.Chem. (1992) 57, 2768-2771). Stifling at roomtemperature produced two clear phases; the lower aqueous phase appearsbright yellow. The mixture was cooled to 40 and 0.2 mL (2 mmol) ofallylbromide was added at once, and the heterogeneous slurry was stirredvigorously at 4-50 for 2.5 h (monitoring by TLC hexane:methanol=1:9).While the mixture was stirred at 0° C , solid sodium sulfite (3 g) wasadded and the mixture was allowed to warm to room temperature andstirred for 1 h. Then 20 niL of ethyl acetate was added to the reactionmixture, and after separation of the layers, the aqueous phase wasfurther extracted with ethyl acetate. The combined organic extracts weredried (MgSO4), concentrated in vacuo and purified by flashchromatography on silica (hexane:methanol=1:9, Rf 0.5), to yield chiral1-bromo-2,3-propanediol. Yield 0.2 g (55.5%). Optical rotation: minus.Nitration to 1-bromo-2,3-dinitroxypropane was achieved using reaction inHNO₃/H₂SO₄ (K. Yang, J.D. Artz, J. Lock, C. Sanchez, B.M. Bennett, A.B.Fraser, G.RJ. Thatcher,J.Chem.Soc., Perkin Trans. (1996) 1, 1073-1075)and the product was purified by flash chromatography on silica gel(hexane:CH2Cl₂=2:3, Rf 0.5). Yield 55.5%. Optical rotation: minus. Thedinitrate IVd was synthesised from chiral 1-bromo-2,3-propanediol by ourusual procedure (K. Yang, J.D. Artz, J. Lock, C. Sanchez, B.M. Bennett,A.B. Fraser, G.RJ. Thatcher,J.Chem.Soc., Perkin Trans. (1996) 1,1073-1075). and purified by flash chromatography on silica (ethylacetate:methanol=9:1). Yield 2.27%. Optical rotation: plus.

Example 22

Chiral Synthesis of Nitrate Vk

The same procedure as described above for racemic Vk was utilized forthe stereospecific synthesis of Vk from the sterechemically resolved,chiral dinitrate IVd.

Example 23

Synthesis of Tetranitrate Vx

The tide compound was synthesised by the reaction of IVd (0.345 g, 1.15mmoles) with captopril methyl ester (0.2 g, 0.865 mmoles) in thepresence of 1 mL of 1M NaOH. The crude product was purified by columnchromatography (Silicagel, ethyl acetate) to afford 0.1 g (18.03%) ofunsymmetrical disulphide. ¹H-NMR(CDCl₃, 300MHz): 5.49-5.61 (m, 11),4.88-4.90 (m, 11H), 4.62-4.74 (m, 1H),4.40-4.55 (m, 1H),3.59-3.78 (m,superpos. 5H), 2.69-3.21 (m, superpos. 5H), 2.14-2.29 (m, 1H), 1.90-2.12(m, 3H), 1.22-1.28 (d, 311). 1³C-NMR(75.48 MHz): a mixture ofenantiomers can be seen: 17.39, 25.20, 29.40, 36.41, 36.51, 38.55,41.94, 42.19, 47.32, 52.56, 59.12, 69.90, 70.29,77.89, 78.00, 173.01,173.48.

Example 24

Synthesis of Nitrate Vq

The tide compound was synthesised by the reaction of Bunte salt (2.4 g,8 mtnoles) with 4,4′-thiobisbenzenetliol (0.5 g, 2 mmoles) in thepresence of 4.4 mL of 1M NaOH. The crude product was purified by columnchromatography (silica gel, hexanes/CH₂CI2: 3/7) to afford 0.28 g(21.82%) disulphide. ¹H-NMR(CDCl₃, 300 MHz): 7.2-7.6 (m, arom 8H),5.42-5.56 (m, 2H), 4.82-4.95 (dd, 2H), 4.55-4.67 (dd, 2H), 2.93-3.15 (m,411).

Example 25

Synthesis of Nitrate Vr

The title compound was synthesised by the reaction of IVd (0.5 g, 1.58mmoles) with ethyl 2-mercapto-3-(3′,4′-methylenedioxy-phenyl) propenoate(0.2 g, 0.8 rmmoles). The crude product was purified by columnchromatography (Silicagel, hexanes/CH₂Cl₂: 3/7) to give Vr (0.1 g,28.09%). ¹H-NMR(CDCl₃, 300 MHz):7.97 (s, 1H), 7.48-7.51 (d, 1H),7.17-7.22 (m, 1H), 6.84-6.89 (d, 1H), 6.05 (s, 2F), 5.48-5.58(m, 1H),4.81-4.89 (dd, 1H), 4.53-4.61 (dd, 1H), 4.25-4.4 (m, 2H), 3.05-3.10 (m,2H), 1.35-1.45 (t, 3H). ¹³C-NMR(75.48 MHz): 14.17, 36.27, 62.15, 69.71,76.57, 101.77, 108.27, 110.31, 125.20, 127.55, 127.87, 146.87, 147.811,149.76, 165.89.

Ethyl 2-mercapto-3-(3′,4′-methylenedioxy-phenyl) propenoate was obtainedby the following route:

-   (1) Ethylisothiocyanate (10 g, 0.115 moles), 7.9 g(O.⁰⁸⁶ moles)    mercaptoacetic acid and 5 mL pyridine in C₆H₆ was refluxed, cooled    and filtered yielding 3-ethylrhodanine, which was used in the next    step without any further purification. Reaction of 3-ethylrodanine    with piperonal in the presence of sodium acetate was performed in    CH₃0H under refluxing for 1 h. The yellow precipitate obtained after    cooling and filtration, was washed several times with CH₃0H on the    filter and crystallizated from CH₃OH to give    3-ethyl-5-piperilidenerodanine. ¹H-NMR(DMSO-d6, 300 MHz):7.72 (s,    1H), 7.1-7.3 (m, 3H), 6.14 (s, 2H), 3.95-4.15(q, 2H), 1.15-1.20 (t,    3H). ¹³C-NMR(75.48 MHz): 12.76, 40.28, 103.07, 110.21, 110.47,    120.68, 127.89, 128.07, 134.01, 149.23, 150.74, 167.57, 193.68.-   (2) 3-Ethyl-5-piperilidene- rodanine (lg, 3.4 mimoles) was added to    a stirred solution of 0.16 g (6.8 mmoles) in 8 mL abs. ethanol and    the mixture was refluxed for 30 min. To the solution cooled to room    temperature 5 mL H₂0 were added and the mixture was hydrolized with    10% HCl and extracted with ether. The ether phase was separated,    dried (MgSO4) and evaporated to an oil. Since the investigation by    TLC of the crude reaction mixture indicated the presence of    piperonal, the reaction mixture was dissolved in CH₂Cl₂ and the    obtained solution was washed with 1M NaOH. The aqueous phase was    extracted twice with CH₂Cl₂ and then neutralized with dilute HCl.    Free thiol was extracted with ethyl ether. After concentration, the    product was purified by column cromatography eluating with    hexane/ethyl ether:8/2. Yield 0.4 g (62.4%). ¹H-NMR(CDCl₃, 300    MHz):7.69 (s, 1H), 7.7.25-7.29 (d, 1H,J 1.46), 7.1-7.18 (m, 1H),    6.85-6.9 (d, 1H, J 8.13), 6.01 (s, 2H), 4.75 (s, 1H), 4.28-4.38 (q,    2H,J 7.12 ), 1.35-1.42 (t, 3H, J 7.13). ¹³C-NMR(75.48 MHz): 14.20,    62.5, 101.41, 108.37, 109.43, 121.06, 125.45, 129.20, 134.68,    147.80, 148.05, 165.43.

Example 26

Synthesis of Nitrate IVs

The title compound was synthesised by the reaction of IVb withdithiothreitol in CH₃0H and was isolated as an oil in 15-20% yield(CAUTION: stench). ¹H-NMR(CDCl₃, 300 MHz): 5.23-5.32 (1H, m), 4.87 (1H,dd,J 12.82, 3.22), 4.68 (1H, dd,J 12.83, 6.09), 2.77-2.94 (2H, m), 1.66(1H, t,J 9.07). ¹³C-NMR: (CDCl₃, 75.48 MHz): 79.39, 69.30, 23.68.

Example 27

Synthesis of Nitrate IVt

The title compound was synthesised by the reaction of nitrate IVs withacetyl chloride in CHCl₃. Isolated yield 50%. ¹H-NMR(CDCl₃, 300 MHz):5.29-5.38 (1 H.m), 4.76 (1 H.dd, J 12.94, 3.11), 4.55 (1H, dd, J 12.94,6.37), 3.30 (IH, dd, J 14.06, 5.98), 3.13 (lH, dd, J 14.61, 6.35).¹³C-NMR: (CDCl₃, 75.48 MHz): 194.10, 77.00, 69.79, 30.42, 27.78. Massspec. m/z (EI+, fragment, %): 240.0 (M⁺, 1.17), 193.9 (N-NO₂, 10.86),148.8 (100). Calculated for C₅H₈N₂O₇S 240.01.

Example 28

Synthesis of Nitrate IIIw

Diethyl 1-chloro-2-tnmethylsiloxypropylphosphonate was obtained byadaptation of literature methods (T.Azuhata, Y.Okamoto, Synthesis (1983)916-917). This phosphonate was quantitatively converted to diethyl1-chloro-2-hydroxypropylphosphonate using CH₃0H. After stirring for 15min the resulting reaction mixture was evaporated to a minimum andsubjected to nitration with a mixture of HNO₃ and H₂SO4 Work-up andflash column chromatography on silica (ethyl acetate eluant) yieldedpure product in 25% yield. 31P (CDCl₃, 162 MHz): 24.60. ¹H (CDCl₃, 300MHz): 5.31-5.45 (m, 1R), 3.92-4.08 (m, 4R), 3.63-3.81 (m, 2H), 2.03-2.30(m, 2R), 1.16-1.24 (superposition of 2 t, 6H,J 7). ¹³C (CDCl₃, 75 MHz):76.83, 62.15 (d,J 6.37), 43.77 (d,J 8.95), 27.08 (d,J 142.00), 15.99(d,J 5.88).

Example 29

Synthesis of Nitrate IIIx

Treatment of IIw with 1 mole of Me3SiBr for 1 h with subsequent additionof CH30H provided the monodealkylated phosphonic acid in high purity.Transformation of the free acid to its sodium salt IIIx was achievedusing the cation-exchange resin Amberlite IR-122-Na+form. 31p (CD₃OD,122 MHz): 17.62. ¹H (CD₃OD, 300 MHz): 5.38-5.63 (m, 1H), 3.75-4.25(superposition of 2 m, 4H), 1.88-2.20 (m, 211), 1.12-1.28 (t, 3H). 1³C(CD₃0D, 75 MHz): 81.14, 61.17 (d, J 5.41), 45.56 (d,J 5.94), 29.35 (d,J131.74), 17.00 (d,J 6.75)

Example 30

The effect of WVk was tested in Xenopus oocytes expressing humanrecombinant GABAA receptors by the two-electrode voltage clamp techniqueas described in Reynolds and Maitra (EurpeanJournalofPharmacologv (1996)314, 151-156.). The control GABA response was substantially potentiatedby the positive control drug, chlormethiazole, at a concentration of 200EM (FIG. 15a). In contrast, a concentration of 200 HM of WVk produced asmaller, but still significant, potentiation of the control GABAresponse in the same oocyte (FIG. 15a). A decreased efficacy with Wksuggests the possibility that it is a partial allosteric modulator ofGABAA receptor function, and may therefore have more selectivebehavioural effects than more efficacious compounds.

The effect of a drug that induces brief periods of sedation/hypnosis inanimals is characterized by loss of the righting reflex (loss of theability of the animal to right its posture when placed on its back). The“loss of the righting reflex” response is a commonly used test forsedative-hypnotic agents. Wk produced a dose-dependent and reversibleloss of the righting reflex in mice when given by intraperitonealinjection at doses of 100 and 200 mg/kg (FIG. 15b). Thus, the organicnitrate WVk exhibits the activity of a sedative/hypnotic, and representsa novel class of compounds that may have utility as new anti-anxiety,sedative and/or hypnotic agents.

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1. A method for treating pain in a subject in need thereof, comprisingadministering to the subject an effective amount of a therapeuticcompound, wherein said therapeutic compound is of the formula (Ia):

F² is a nitrate group or an organic radical which may be joined in acyclic ring system with G², and which may contain inorganic counterions;E is a methylene group; G¹ is a methylene group or does not exist; F¹ isH; and G² is joined with F² to form a cyclic system or is R^(N)-Z^(N);wherein R^(N) is an organic radical possessing a heteroaryl groupcontaining a P or S atom, where said P or S is positioned β, γ, or δ toa nitrate group; and Z^(N) is W^(N) _(nwn)-X^(N) _(nn)-Y^(N) _(oo);wherein mm, nn, oo are 0 or 1 and W^(N), X^(N), Y^(N) are NH, NR^(NN),CO, O, or CH₂; wherein R^(NN) is a C₁-C₁₂ alkyl group.